Army Badges Recognition Replacements Application Form

Phone/Fax: 1-310-532-0634
United States Army
Qualification 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 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 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:

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):

Paygrade
Enlisted
Warrant
Officer
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 - $21.20 Document Only
U.S. delivery - Bond Enclosure $25.70
Navy
Regal
Black
Military Standard Issue

U.S. delivery - EnDurable Frame, Acrylic Brown, $27.70

U.S. delivery - EnDurable Frame, Acrylic Black, $27.70

U.S. delivery - Gold Color Frame, $32.70 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 to receive the Official, full size Badge?

No, I already have the hardware.

Badge Type:

Yes, please include the official badge I selected above and add an additional $8.00 to my total.

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 [.70] cents extra)?
Yes, add 70 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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