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.

Date of Service *

Funeral Home & Chapel Name *

Name of Deceased *

Time of Service *

Service Start Location *

Please specify

Address Of Service Location *

City *

Zip Code *

Escort Reporting Time *

Escort Reporting Location *

Number of Escorts Required *

Final Destination (Starred Destinations See Below) *

Please select drop point. *

Escort will go to cemetery

Escort will drop at county line

This is a Graveside Service, Procession ends at Church

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 the Escort 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