Phone/Fax: 1-562-422-4100 (Pacific Time Zone)

Army Warrant Officer Appointment
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 Mark Your DD-214
    or Other Military Document!!!

    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).

    Rank:

    Date of Appointment:

    Recipient's LAST Name:
    FIRST Name:
    MIDDLE name:
    Title (Must appear on military documentation):Jr Sr II III IV

    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:

    Please choose between ASAP or Monthly shipping...

  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped As Soon As Possible.
  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped in monthly groups of...

      Ship 1 of my Application Forms per month
      Ship 2 of my Application Forms per month
      Ship 3 of my Application Forms per month
      Ship 4 of my Application Forms per month

    Bill my charge/debit card and send me an email receipt between the 1st and 5th day of each month for each shipment. Please note that I am using a credit/debit card that will not expire before all of my monthly shipments have been sent to me.

    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

    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 - $9.50 Black & White (No Color)
  • U.S. delivery - $21.10 Document Only
  • U.S. delivery - Bond Enclosure $25.60
    Navy
    Regal
    Black
    Military Standard Issue
  • U.S. delivery - EnDurable Frame, Acrylic Brown, $27.60
  • U.S. delivery - EnDurable Frame, Acrylic Black, $27.60
  • U.S. delivery - Gold Color Frame, $32.60 Gold
  • I do not want the Display Recognition. I am requesting the hardware items (medal, badge, ribbon or patch) if they are available for this award, below. (Additional shipping cost applies to non-certificate requests.)

  • 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 sixty-five [.65] cents extra)?

    • Yes, add 65 cents to my total

    • No, I don't want to track my package

    • Ignore this final Question if you will EMAIL or have previously EMAILED a copy your DD-214...

      Would you like your mailed DD-214 scanned by The War Library and integrated into your 201A Award Report that will be emailed to you when your requested item(s) are sent to you? The scanning fee is $3.00 (a one-time fee)

    • Yes, add a one-time $3.00 to my total to Scan and Integrate my DD-214 into my Award Report

    • No, I will accept my Award Report without my DD-214 appearing in the Report


    • 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 Ste 319
      Long Beach CA 90805-7549Phone/Fax: 1-562-422-4100 (Pacific Time Zone)