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.

1) Date of Service *

3) Time of Service *

This is Standard Time not Military Time

4) Funeral Home Chapel Name *

5) Name of Deceased *

6) Where is Service to Take Place *

7) Address Of Service Location (If other than Funeral Home)

8) Final Destination (Starred Destinations See Below) *

9) If your destination is not listed above, Please provide details in Alternate Destination below.

10) Cemetery Mandatory Arrival time *(ONLY IF THIS IS A GRAVESIDE SERVICE)

This is Standard Time not Military Time

11) Escort Reporting Time * (Please select AM or PM)

This is Standard Time not Military Time

12) Escort Reporting Location *

13) Number of Escorts Required *

14) Please select drop point. *

Escort will go to cemetery

Escort will drop at county line

Procession ends at Church

Graveside Service Only
with Procession Forming at Funeral Home

15) Additional things that We Should Know.

16) Request Submitted By *

17) Phone Number (Please Include Area Code) *

18) Email Address *

19) Email Alternate (not required)

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