Providence Cardinal Order Form

Begin Your Order
Start your memorial at your own pace.

Thank you for choosing to create a glass memorial with us. This process is intentionally different from a typical online checkout — it is designed to be gentle, step-by-step, and respectful of your timing. You’ll select your memorial piece and enter your contact and payment information on this page.
Payment information is collected now, but your card will only be charged on the final page when you click “Place Order.”

You may save your progress and return at any time using the Save & Continue button — there is absolutely no rush. Once your order is reserved, we will guide you through dedication details, shipping information, and authorization for handling cremated remains, all in the following steps. We are honored to help create something meaningful for you and your family.

Memorials*

CardinalA cherished symbol of visitation and remembrance. The Cardinal memorial piece is a vivid tribute to those who continue to appear when we need them most.

$300 Quantity
Item subtotal:$0.00

HeartA timeless symbol of love and connection. The Heart memorial glass sculpture embodies the enduring bond you shared, holding the spirit of your loved one close forever.

$300 Quantity

OwlA tribute to wisdom, insight, and soulful presence. The Owl memorial glass piece honors a life lived with quiet strength and deep understanding.

$300 Quantity

Galaxy StarFor those who lit up your life. The Star memorial piece shines with celestial beauty, representing eternal light and guiding presence in the night sky of your memories.

$300 Quantity

FlameA symbol of passion and spirit. The Flame memorial sculpture captures the energy and warmth your loved one brought into the world, now forever part of the art.

$300 Quantity

TreeRooted in memory, reaching toward the sky. The Tree sculpture is a beautiful reminder of growth, strength, and the cycles of life and legacy.

$300 Quantity

StarfishGentle and resilient, the Starfish memorial piece evokes memories of the ocean and eternal renewal, perfect for someone who felt at home by the sea.

$300

Color	Quantity
Multi
Blue

Rose PaperweightA classic tribute to beauty and grace. The Rose memorial sculpture speaks of love in bloom, honoring a soul who brought elegance and kindness to life.

$300 Quantity

Calla LilySymbolic of purity and transition, the Calla Lily is a serene, graceful piece, perfect for celebrating a gentle spirit and a peaceful legacy.

$150 Quantity

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Subtotal

$0.00

Tax

$0.00

Shipping

$0.00

Total

$0.00

Payment Information (processed only on the final page)

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

Your Contact Details

Purchaser
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Your Address

Street Address

Street Address Line 2

CityState

Zip Code
Today

MonthDayYear
Date
Shipping Email
example@example.com
You can complete this form all at once or take your time — whatever feels right.

Many families save their progress and return later, and that’s perfectly okay. We’ll guide you step by step, gently and clearly, as you move through the details.
You can save your progress at any time and return using the link we send you.

When you’re comfortable, click Next to continue.

Shipping Information
Tell us where to send your finished memorial and ashes collection kit.

This page helps us ensure that everything arrives exactly where it needs to go.You can select your own address, someone else’s, or a separate location if needed — whatever works best for your situation.
Shipping for the Finished Memorial
Who should receive the finished memorial piece?

Ship to meShip to someone else
Recipient Name

First NameLast Name
Recipient

First NameLast Name
Recipient Phone Number
Please enter a valid phone number.
Recipient Phone
Please enter a valid phone number.
Recipient Shipping Address

Street Address

Street Address Line 2

CityState

Zip Code
Recipient Shipping

Street Address

Street Address Line 2

CityState

Zip Code
Shipping for the Ashes Collection Kit
Where should we send the Ashes Collection Kit?

Send to meSend to the memorial recipientSend to a different address
Kit Recipient Name

First NameLast Name
Kit Recipient

First NameLast Name
Kit Recipient Phone Number
Please enter a valid phone number.
Kit Recipient Phone Number
Please enter a valid phone number.
Kit Recipient Shipping Address

Street Address

Street Address Line 2

CityState

Zip Code
Kit Recipient Shipping

Street Address

Street Address Line 2

CityState

Zip Code
Optional Notes
Is there anything we should know about delivery or receiving the package?
(Examples: secure building, gate code, preferred delivery spot)
You can save your progress at any time and return using the link we send you. When you’re ready, click Next to continue.

DEDICATION CARD DETAILS
“Every memorial is as unique as its recipient; each one’s creation is its own journey. By learning as much as possible about the individual I'm working with, I transfuse that energy and intention into the glass art. I often feel like the memorial is making itself—I’m just the vessel being used to create it.”

-- Memorial Glass Artist, Benjamin Giguere
Dedication Card Details

Share the name and date you’d like to appear on the dedication card.
This card accompanies your finished memorial piece.You’re welcome to keep these details simple, or add a personal touch — whatever feels right for you. If you’re not sure yet, you can always save your progress and return later.There are no wrong answers here. We’ll follow your lead.
Loved Ones Names
(The name/names you’d like printed on the dedication card)
Dedication Date
(The date/dates you’d like printed on the dedication card)
Optional Questions (for artistic context)

These questions help our artists understand the person behind the memorial. You may answer one, both, or neither.
What did they love to do? (Optional)
(Hobbies, passions, daily joys — anything you’d like to share.)
Is there a memory you would like to share? (Optional)
(A favorite moment, story, or detail that reflects who they were.)
You can save your progress at any time and return using the link we send you. When you’re ready, click Next to continue.

AUTHORIZATION & AGREEMENT
Authorization to Handle Cremated Remains

Please review and sign this required agreement.
To create your memorial piece, we are required to have a signed authorization confirming that:
- you have the legal right to provide the remains, and
- you understand our process for receiving, using, and returning the Memorial.
You may expand the agreement below to read the full terms.
Once you’ve reviewed it, please check the box to agree and sign electronically.

Full Agreement
Full Agreement

This Agreement is entered into on the date of {date_today}, between Gather LLC (“Gather”) and {purchaser_name} (“Customer”), concerning the cremated remains of {loved_ones_name} (the “Decedent”).

1. Purpose

Gather creates unique glass artwork designed to incorporate cremated remains as a memorial to the Decedent (the “Memorial”).
Customer has selected a memorial glass product for this purpose (the “Glass Product”).

2. Delivery of Remains
Customer shall deliver to Gather a portion of the Decedent’s cremated remains (“Remains”) using the ashes collection kit that Gather provides (“Container”).
Customer shall ship the Remains to Gather using USPS Priority Mail Express, as required by federal mailing regulations.

3. Use of Remains
Any Remains not used in creating the Memorial will be respectfully and thoughtfully released in nature at our nearby farm or at the sea coast.

4. Risk of Loss
Customer assumes all risk of loss in the event the Remains are lost during shipping or during the creation of the Memorial.

5. Legal Authority
Customer warrants that they have the full legal authority to provide the Remains and direct their use for the creation of the Memorial.

6. Delivery of the Memorial
Customer authorizes Gather to ship the completed Memorial to the Customer using the United States Postal Service.

7. Indemnification
Customer agrees to indemnify and hold Gather harmless from any claims, damages, losses, liabilities, or expenses arising from the creation or mailing of the Memorial.
Required Consent*

I have read and agree to the terms of this Agreement.
Signature*

Powered by Jotform SignClear
Your Signature
Signed Date*

MonthDayYear
Today's Date
Next Step — Review

You can save your progress at any time and return using the link we send you. When you’re ready, click Next to continue.

Review Your Order

Please take a moment to review the information below before placing your order.
You may use the Back button to make changes to any section.
When everything looks correct, click Place Order to finalize your memorial order and process your payment.
Your Information

Purchaser Name: {purchaser_name}
Email: {purchaser_email}
Phone: {purchaser_phone_number}
Purchaser Address: {purchaser_address}
Recipient Information

Recipient Name: {recipient_name}
Recipient Phone: {recipient_phone}
Recipient Address: {recipient_shipping}
Collection Kit Information

Kit Recipient Name: {kit_recipient_name}
Kit Recipient Phone: {kit_recipient_phone}
Kit Recipient Address: {kit_recipient_address}
Dedication

{loved_ones_name} — {dedication_date}

{love_to_do}
{memory}
Authorization

Authorization Agreement:
{requiredConsent}
Signed By:
{purchaser_name}
Signed Date:
{signedDate}
Agreement Date:
{date_today}
Total Charged Today:
${memorials}
Place Order

You’re almost done. Please take a moment to review everything above.You can go back to make changes, save your progress to return later, or click Place Order when you’re ready.
Order Name
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Should be Empty:

Begin Your Order

Start your memorial at your own pace.

Payment information is collected now, but your card will only be charged on the final page when you click “Place Order.”

Payment Information (processed only on the final page)

Your Contact Details

You can complete this form all at once or take your time — whatever feels right.

You can save your progress at any time and return using the link we send you.

Shipping Information

Tell us where to send your finished memorial and ashes collection kit.

Shipping for the Finished Memorial

Shipping for the Ashes Collection Kit

Optional Notes

DEDICATION CARD DETAILS

Dedication Card Details

Optional Questions (for artistic context)

AUTHORIZATION & AGREEMENT

Authorization to Handle Cremated Remains

Full Agreement

1. Purpose

Next Step — Review

Review Your Order

Your Information

Recipient Information

Collection Kit Information

Dedication

{loved_ones_name} — {dedication_date}

Authorization

Place Order