Civilian Welfare Council Condolence Request

Requestor's Name(Required)

First Last

Requestor's Office Symbol(Required)

Requestor's Email(Required)

Requestor's Phone Number(Required)

Requested on behalf of (Associate's Name)(Required)

Associate's Email(Required)

Name of the Deceased(Required)

Deceased's Relationship to Associate(Required)

Please select what you would like funds to go towards(Required)

please note: if you are selecting “donation to organized charity,” the organization must be a 501c3. GoFundMe and similar accounts are not permitted.

Flowers to funeral home or church

Planter to Associate

Donation to organized charity

Deliver Flowers to:

Date of service/viewing

Time of service/viewing

Recipient (Funeral Home/Associate/Charity)(Required)

Recipient's Phone Number(Required)

Address of Recipient (Funeral Home/Associate's Home/Charity)(Required)

Street Address City State / Province / Region ZIP / Postal Code

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