Coast Guard Bicentennial Service Ribbon
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail 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.

    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 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 USPS money order please indicate:

    • I will mail a check along with my application and documentation. The Library will receive my envelope within 10 days from today.

    • I will mail a USPS money order along with my application and documentation. The Library will receive my envelope within 10 days from today.

    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

    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 - $7.50 Full Color
  • U.S. delivery - $21.15 Full Color Document Only
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure
  • I want ALL or SOME of my Certificates (minimum 20) in pdf format that I can print continuously, shipped to me on a CD rom that I can make copies of. (Library Note: See below for details)
  • 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 the full-color Wallet-Size Card Certificate along with one of the above full-size color Certificates (Wallet Cards are available only when a Certificate is requested now or previously.)
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No
    I want Certificates in pdf format on a CD rom...

  • I want ALL of my Certificates in full color; $8.75 per Certificate
  • I want SOME of my Certificates (minimum 20) in full color; $8.75 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; $6.75 per Certificate
  • I want SOME of my Certificates (minimum 20) in Black&White; $6.75 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 to receive the Official, Coast Guard Overseas replacement ribbon?

  • Yes, please include the official ribbon and add an additional $4.00 to my total.

  • No, I already have the hardwear.

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

  • No, I will obtain the free jpg copy
  • Yes, please include a PUBLISHED VERSION of the Medal Will for a MALE heir of my Awards and add $4.00 to my total
  • Yes, please include an EMAILED VERSION Medal Will for a MALE heir of my Awards and add $2.50 to my total
  • Yes, please include a PUBLISHED VERSION of the Medal Will for a FEMALE heir of my Awards and add $4.00 to my total
  • Yes, please include an EMAILED VERSION Medal Will for a FEMALE heir of my Awards and add $2.50 to my total

  • 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. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed or emailed. (Non-personalized items such as hardwear may be exchanged or returned within ten days of delivery. Name-Personalized items such as Certificates that are produced uniquely for a recipient may not be exchanged or returned.)

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

Print a copy for yourself before clicking the bar below...