This web page is for Funeral Home Directors to use for data entry for memorial service internet-video project submission and payment of appropriate charges. Please complete the form below and note the fields with " * " by the fields. Those fields indicate required input in order to complete this process.

When completed, click on submit button at the bottom of this form. This will submit the information and create a production reservation order and scheduling for your submission.

If you have any questions call LifeHonor at 605-277-8700

Funeral Home Information

Account Number *

Funeral Home Name *

Funeral Home Address *

Funeral Home Address #2

Funeral Home City *

State *

Zip Code *

Phone Number *

Contact Name *

email address *

Deceased Information

Gender *

Male

Female

First Name *

Middle Name

Nic Name

Last Name *

Street Address *

Address Line 2

City *

State *

Date of Birth (mm/dd/yyyy) * +

Date of Death (mm/dd/yyyy) * +

Memorial Service (MS)Information

Memorial Service Date (mm/dd/yyyy) * +

MS Location Name * 🛈

MS Street Address *

Address Line 2

MS City *

MS State *

Additional Production Information Needed

Funeral Home web site address

Family specific funeral home web site address

Please enter your desired password for the video to be played. All video content will be password protected. *

Choice of Theme for Video/Website Production *

010 - Angels (Heaven & Light)

020 - Angels (Trumpet & Heaven)

030 - Autumn (Leaves, Tree, SlowMotion)

040 - Autumn (Leaves, Ground, SlowMotion)

050 - Beach & Waves

055 - Bible

058 - Butterfly

080 - Candles (Three Orange)

100 - Candles (TeaLights)

140 - Clouds (Light & Puffy)

160 - Cross (3 at Sunset)

170 - Eagles (Trees Background)

172 - Eagles (Blues Sky & SlowMotion)

060 - Flowers (Pink Blossomes)

180 - Flowers (Falling Rose Petals)

186 - Flowers (Pink Rotating Roses)

188 - Flowers (Whites Roses)

190 - Flowers (Red Roses)

198 - Foot bridge in Autumn

200 - Golf

250 - Heaven (Light Rays)

252 - Heaven (Stairway)

300 - Mountains (Panning)

350 - Music

400 - Ocean Waves

450 - Patriotic (Flag in Slowmotion)

452 - Patriotic (Flag Waving)

456 - Patriotic (Flag Closeup)

585 - Stained Glass

600 - Sunburst (Red)

625 - Sunset (Wildflowers)

630 - Sunset (Galilee Sea)

634 - Sunset (Galilee Sea with Trees)

638 - Sunset (Vegetation)

700 - Swans

800 - Waterfall (Scenic)

802 - Waterfall (Slow Motion)

804 - Waterfall (Mist)

Completed "Recording Broadcast Release" Form (Scanned PDF file) Upload *

Completed "Funeral Service Music Log" Form (Scanned PDF file) Upload *

Deceased Image/Picture Upload *

Optional Family PowerPoint (or other) Tribute Upload

Do you wish to have the optional "Comfort Page" included with your video produciton? *

Yes

No

If you answered yes to the above question, please choose which comfort page you wish to use.

Biblical - Let not your heart be troubled…. John 14:1-3

Biblical - The Twenty-Third Psalm

Biblical - The Lords Prayer

Biblical - Ecclesiastes III

Spiritual - Treasured Seasons

Spiritual - God hath not promised….

Spiritual - MY NAME Is Written

Spiritual - Serenity Prayer

Spiritual - Footprints in the Sand

“Mom” - Tribute To Mom

“Mom” - What is a Mom?

“Mom” - One Mother

“Grandmother” - Grandmother

“Dad” - Tribute To Dad

"Dad" - DAD

Poem - Do Not Stand

Poem - The Journey’s Just Begun

Poem - After Glow

Poem - I Wish You Enough

Poem - If I Should Go

Thank you for choosing a LifeHonor Theme!

Final Notes and Submissions

Additional Notes and Comments Regarding this Order

I am in agreement with LifeHonor Terms of Service and Privacy Policy. *

Yes, I am in agreement

LifeHonor Terms Of Service

LifeHonor Privacy Policy

LifeHonor Prepaid Code: *

Please check this item to activate your order through your pre-paid status. Then, press the "continue" button at the bottom of the page. You will be taken to an order confirmation page - showing $00.00 for this order, because you have pre-paid - and PayPal is NOT being charged for this order.

LifeHonor Video-Internet Services PREPAID

Thank you for the opportunity to serve you.

Contact Information

PO Box 796, Ankeny, IA 50021

605-277-8700