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(212) 942-4000
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Full Name
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Email Address
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Phone Number
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Relationship to the Pre-Need Client
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Pre-Need Client's Information
Full Name
*
:
Deceased's Mailing Information
Address:
City:
Country:
State/Province:
Zip/Postal code:
Date of Birth:
Age:
Place of Birth (City, State, and Country):
Social Security:
Race:
Ethnic Origin:
Education:
Occupation:
Type & Place of Business :
Ever in US Armed Forces? :
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No
Pre-Need Client's Father & Mother Information
Father's Name:
Mother's Name:
Mother's Maiden Name:
Pre-Need Client's Marital Information
Marital Status:
Spouse's Name:
Spouse's Maiden Name:
This person will be responsible for finalizing the funeral arrangements upon death
Pre-Need Client's Next of Kin Information
Next of Kin's Name:
Relationship to Deceased :
Mailing Information
Address:
City:
Country:
State/Province:
Zip/Postal code:
Phone Number :
Pre-Need Client's Disposition Information
Preferred Disposition:
Burial
Cremation
Do you already own a grave plot? :
Yes
No
Preferred Cemetery:
Pre-Need Client's Funeral Service Information
Do you would like a Visitation/Wake at the Funeral Home? :
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No
Do you would like a Church/Funeral Service? :
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No
Preferred Church/Place of Service:
Special Instructions
Other Information:
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Contact Us
Riverdale Funeral Home Inc.
5044 Broadway
New York, New York 10034
P: (212) 942-4000
F: (212) 942-4626
E: riverdalefuneralhome@verizon.net
Quick Links
Our History
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About Us
Home
Our History
Calendar of Events
Our Staff
Map & Directions
Our Facilities
Our Services
Contact Us
Leave Us a Review
Funeral Planning
Make At-Need Arrangements Online
When Death Occurs
Burial Services
Cremation Services
General Price List
Eulogies & Obituaries
FAQ
Funeral Etiquette
Veterans
Legal Advice
Grief Resources
Pre-Planning
About Pre-Planning
Make Pre-Need Arrangements Online
Resources
Cemeteries
Churches
Funeral Music Selections
Merchandise
Flowers
Prayer Cards
Sutton Caskets
Showroom
Batesville Merchandise
Matthews Merchandise
Vaults
Urns, Keepsakes, Jewelry
Obituaries & Tributes
Obituaries
Send Flowers
Request a Quote
Español
Solicitar una Cotización/Request a Quote
Envíos Fúnebres a República Dominicana/International Funeral Shipping to the Dominican Republic
Cementerios/Cemeteries
Flores/Flowers
Oraciones para las Tarjetas/Prayer Cards
Ataúdes Sutton/Sutton Caskets
Sala de exposición/Showroom
Mercancía de Batesville/Batesville Merchandise
Mercancía de Matthews/Matthews Merchandise
Urnas, Recuerdos, Joyería/Urns, Keepsakes, Jewelry