Questions About This Form? Use Email

Phone: 1-562-422-4100

Confederate States of America
Marksman Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail or fax this completed form, along with a photocopy of the veteran's official Civil War service document(s) to the address below.

    Charge card or Debit card applicants: To expedite shipment of your Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your military or veteran document(s).



    Select Weapon or Profession from List:

    Other Weapon, Profession or Rank not listed above:

    Please indicate Service Branch:Army Navy

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

    Is this veteran currently living, deceased or KIA:
      LIVING
      DECEASED
      KILLED IN ACTION

    Rank Title (Please Do Not Abbreviate):

    OPTIONAL: Unit or Vessel (Please Do Not Abbreviate):

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

    Street Address:
    City:
    State:
    ZipCode:
    Phone:

    Your full and complete contact email address:

    The veteran's Civil War Service or Serial or Record or Pension 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:

    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:

    I want to purchase the Full Color...

  • PDF emailed (full color, printable) ($7.50) (No shipping fee)
  • Document shipped ($24.50)...
       Document only with wallet card ($30.50)
  • Document shipped in Bond Enclosure ($29.50)...
       Document in Bond Enclosure with wallet card ($35.50)

    • (The shipping totals above include the USPS - Priority Mail shipping fee)

    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 twenty [.20] cents extra)?

  • Yes, add 20 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
    817 East Via Carmelitos
    Virginia Building 319
    Long Beach CA 90805-7549
    Phone: 1-562-422-4100

LINK: Policy Statements On Display Recognitions and Hardwear
Name-personalized items that are produced uniquely for a recipient may not be exchanged or returned. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

I have read and understand the Certificate Return/Exchange Policy printed above.

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