Funeral Request Form
We at Southland consider it a privilege to be asked to host your Loved One's funeral services.

We will make every effort to accommodate your request, however please be aware events already on our calendar cannot be cancelled/rescheduled.

Your request will be reviewed as quickly as possible and you should expect to hear from us within 24 hours from the time you submit this form.

Your Contact Information
First Name *
Your answer
Last Name *
Your answer
Phone *
Your answer
Email *
Your answer
Relationship To Deceased? *
How are you related to the deceased person?
Do you attend Southland? *
(If you represent a Funeral Home, please select "No")
If so, which campus?
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