Phone: 1-562-422-4100

Army Enlisted Promotion
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail or fax this completed form, along with a copy of your or the veteran's DD-214, WD AGO 53-55 or other pre-arranged military document(s) to the address below.

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The DD-214
    Or Other Military Document Photocopy
    You Will Mail.

    Charge card or Debit card applicants: To expedite shipment of your Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your DD-214, WD AGO 53-55 or other, pre-arranged military document(s).

    Recipient's LAST Name (as it appears on the Report of Separation):
    FIRST Name (as it appears on the Report of Separation):

    MIDDLE name (as it appears on the Report of Separation):
    Title (Must appear on military documentation):Jr Sr II III IV

    Rank:

    Date of Promotion:

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Recipient's Service Number:


    If you are sending a check or Money Order please indicate:

    • I will mail a check along with my application and documentation
    • I will mail a money order along with my application and documentation

    Charge or Debit Card applicants, please complete the following:

    Your Name as it appears on your charge or check debit card:

    Payment Method
      Check Debit
      Visa
      MasterCard
      American Express
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    After printing this form for mailing, please sign here:


    International shipping cost (U.S. veteran living outside the United States, please add the shipping cost you were quoted...

    TOTAL ADMIN PROCESSING/DELIVERY:

  • .PDF Emailed - $7.50 Full Color
  • U.S. delivery - $22.35 Full Color Document Only
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure
  • I do not want the Display Recognition. I am requesting the hardwear items listed below (medal, badge, ribbon or patch) if they are available for this award. (Shipping cost applies to non-certificate requests.)

    Would you like to receive the official, Lapel replacement rank insignial (1 Pair [two insignia])? (Cost: $8.00/pair additional)

    Rank:

    If you requested to receive 1 pair (2 each) replacement insignia's above, which type of Insignia would you like?

    • Polished Brass

    • Combat Subdued

    • No, I already have the hardwear

    Would you like to receive the official, enlisted uniform sleeve patch. (Gold on Green, 1 Pair [two patches])?

    Rank:


    Would you like a published copy of My Military Medal Last Will And Testament?

    • Yes, please include a Medal Will for a male heir of my medals and add $4.00 to my total

    • Yes, please include a Medal Will for a female heir of my medals and add $4.00 to my total
    • No, I will obtain the free jpg copy

    • Would you like to track your package through the United States Post Office after it has been shipped (for seventy-five [.75] cents extra)?

      • Yes, add 75 cents to my total
      • No, I don't want to track my package

      Click Here if you are a Prior Applicant who's DD-214 is on file
      New Applicants Click Here

      Your Application Form is now complete. Print, Sign and Mail this completed form to the address below along with the required military-issued Report of Separation or other (pre-approved) document(s). You may (OPTIONAL) email this form for faster processing. However, you must still mail or fax a copy of your military document(s).

      Records Chief (REC-AMW)
      The American War Library
      817 East Via Carmelitos
      Virginia Building 319
      Long Beach CA 90805-7549Phone: 1-562-422-4100