Phone: 1-562-422-4100

Iraq Combat Campaign Service
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Click the button at the bottom of this completed form to email it to The War Library, along with a copy of your or the veteran's DD-214 (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 or Email.

    I am selecting ONLY ONE campaign credit certificate
    I am selecting MORE THAN ONE campaign credit certificate

  • March 19 to May 1, 2003: Liberation of Iraq -- Yes No
  • May 2, 2003 to June 28, 2004: Transition of Iraq -- Yes No
  • June 29, 2004 to Dec. 15, 2005: Iraqi Governance -- Yes No
  • Dec 16 2005 to Jan 09 2007: National Resolution -- Yes No
  • Jan 10 2007 to Dec 31 2008: Iraqi Sruge -- Yes No
  • Jan 01 2009 to Date To Be Determined: Iraqi Sovereignty -- Yes No

    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

    Service Branch:

    Rank Title (Please Do Not Abbreviate):

    Paygrade
    Enlisted
    Warrant
    Officer


    I have not moved. My current address info is on file from a previous application

    Address:
    City:
    State:
    ZipCode:
    Phone:


    Full and complete contact email address:

    Please enter the FIRST EIGHT DIGITS ONLY of the Recipient's Service Number:

    Date First Tour Began In Iraq
    Date Final Tour Ended In Iraq


    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:

    -- My current Card information is already on file from a previous Application

    If your Card information is not on file, 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
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    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 - $7.50 Full Color
  • U.S. delivery - $22.35 Full Color Document Only
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure
  • 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
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No
    SKIP THIS SECTION IF YOU ARE NOT REQUESTING A CD-ROM...
    I want Certificates in pdf format on a CD rom...


  • I want of my Certificates (minimum 20) in full color; $7.50 per Certificate on CD-ROM. I will be emailing a list of the 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 track your package using the internet 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..