Crown Order Form

MISS USA Crown

MISS Teen USA Crown

"*" indicates required fields

Crown Usage Agreement

1. I am choosing to purchase an optional crown for use prior to the State Pageant.

2. Usage of my crown will be completed at the completion of the State Pageant.

3. I understand if I use this crown for public appearances that are NOT approved, or in situations exhibiting bad taste or poor judgment (i.e. alcohol, nudity, foul language) that my participation in the State Pageant may be terminated and any fees paid will be forfeited.

4. I understand that I may not wear this crown to promote any pageant system other than the Miss Universe Organization.

Crown Usage Agreement*

I agree to all of the terms listed above.

Contestant Information

Name*

First Last

Which Pageant Are You Competing In?*

Title*

Phone

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Crown Type*

Cost $195

Teen

Miss

Shipping & Insurance

5% Online Convenience Fee*

Price: $0.00

Total

Non-Refundable*

I understand that this crown order is non-refundable.

Payment

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Cardholder's Address

Street Address Address Line 2 City State ZIP Code

Cardholder's Phone*

Cardholder's Email*

Cardholder's Signature*