Brust Funeral Home - Information Request

REQUEST FOR INFORMATION

You can e-mail this form, or print it and mail it to:

Brust Funeral Home
135 S. Main St.
Lombard, IL 60148

I would like to speak with a planning counselor regarding:

Preplanning my funeral

Preplanning a funeral for a relative.

My options regarding cremation.

How I can plan a funeral for my aging relatives and pay for it so that it can be an exempted asset if they have to go on Medicaid Public Assistance.

Other:
Name:
Address:
City, State, Zip:
Phone:
Birth Date:
E-mail Address:
Marital Status:		Single Married Widowed Divorced

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