Escort Request Form

Your first contact/request should be done through your choice of a funeral home and the funeral director. They should offer a funeral escort, if needed, and at that time please ask for Police Motorcycle Escort and no other.

Additional things the Escort Should Know

Date of Service *

Time of Service * (Please select AM or PM) This is Standard Time not Military Time

Escort Reporting Time * (Please select AM or PM) This is Standard Time not Military Time

Number of Escorts Required *

Funeral Home Chapel Name *

Name of Deceased *

Service Start Location *

Please specify

Name of Service Location *

Address Of Service Location *

Escort Reporting Location *

City *

Final Destination (Starred Destinations See Below) *

Please select drop point. *

Escort will go to cemetery

Escort will drop at county line

Procession ends at Church

Does the procession have to be at the destination by a certain time? *

Yes

If your destination is not listed above, please provide the name and location (including street address, city and zip code) of your destination in the field below:

Alternate Destination:

Additional things that We Should Know.

Request Submitted By *

Phone Number (Please Include Area Code) *

Email Address *

Email Alternate (not required)

Please type the letters and numbers you see below
Note: Case-sensitive