Rank Title (Please Do Not Abbreviate):
I have not moved. My current address info is on file from a previous application
Phone ( NO SPACES OR DASHES):
Full and complete contact email address:
SERVICE NUMBER: Enter the veteran's FIRST FOUR DIGITS ONLY ) (Do Not Enter any Alpha characters. Digits only.
SECOND FOUR (or remaining) DIGITS ONLY
Full name of the Unit you served in:
Month and Year Arrived Combat Assignment:
Month and Year Departed Combat Assignment:
If you are sending a check or USPS money order please indicate:
CHARGE or DEBIT CARD applicants:
-- My current Card information is already on file from a previous Application
If your Card information is not on file, please Complete the following...
International shipping cost (
U.S. veteran living outside the United States, please add the shipping cost you were quoted...
TOTAL ADMIN PROCESSING/DELIVERY :
I want to purchase the Full Color...
PDF emailed ($7.50) (No shipping fee)
Document shipped ($22.45)...
with wallet card ($28.95)
Document shipped in Bond Enclosure ($27.45)... with wallet card ($33.45) (The shipping totals above include the USPS - Priority Mail shipping fee)
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 Agency Name (name of unit, vessel, office, school, etc.)
City, State, Zip
Would you like to receive the Official, full size Combat Action Badge?
Yes, please include the official Badge and add an additional $9.75 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 Medal Will for a MALE heir of my Awards and add $4.00 to my total
Yes, please include a Medal Will for a FEMALE heir of my Awards and add $4.00 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
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.)