Army Special Badge Recognition Replacements Application Form

United States Army Special Badge
Recognition Replacements 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, NAVPERS 553, NGB 22, 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 Recognition Replacement you may email this form today. Your Recognition Replacement will be prepared and awaiting the arrival of your military document(s) and a printed copy of this application.

Badge Type:
Other Badge not listed above:

Place Received:
Date Received:

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

Rank Title (Please Do Not Abbreviate):

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:

I would like the following Display Recognition...
.PDF Emailed - $9.50 Black & White (No Color)
U.S. delivery - $21.20 Full Color Document Only
U.S. delivery - $25.70 Full Color Document in Bond Enclosure
I do not want the Display Recognition. I am requesting the hardware 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 the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No
I want Certificates in pdf format on a CD rom...

I want ALL of my Certificates in full color; $10.00 per Certificate
I want SOME of my Certificates (minimum 20) in full color; $10.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
I want ALL of my Certificates in Black&White; $8.00 per Certificate
I want SOME of my Certificates (minimum 20) in Black&White; $8.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
No CDrom

Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?
(Fee: $3.50)
No.
Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:

Official's name
Official's Title
Official's Agency Name (name of unit, vessel, office, school, etc.)
Address
City, State, Zip

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
Building Two, 16907 Brighton Avenue
Gardena CA 90247-5420
Phone/Fax: 1 310 532 0634

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