2025 State Heart of the USA Ad Submission
State Pageant
*
Please Select
Florida
Georgia
Contestants Name
*
First Name
Last Name
Purchaser Name/Company Name
*
Purchaser Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Purchaser Email Address
*
Purchaser Phone Number
*
Purchaser Signature
*
Date Signed
*
/
Month
/
Day
Year
Date
Ad Paid Via (Check One)
*
Cash App - $Seritamissheart
Venmo - @seritascanlan01
Mailed Check - Made out to Serita Scanlan
Button on Website
Requesting an Invoice
Print Ready Ad Submission
*
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