Phone: 1-562-422-4100 (Pacific Time Zone)

Civil War 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 Be Sending.

    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):


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

    Address:
    City:
    State:
    ZipCode:
    Phone (NO SPACES OR DASHES):


    Full and complete contact email address:

    Please enter the FIRST EIGHT DIGITS ONLY of the Recipient's Service Number (Do Not Enter any Alpha characters. Digits only.):

    Date Entered Military Svc
    Date Discharged


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

    Allatoona, Battle of Select Unselect
    Antietam Select Unselect
    Appamattox Cpn Select Unselect
    Appomatox Campaign Select Unselect
    Appomatox Court House Surrender Select Unselect
    Arkansas Post (Fort Hindman), Battle of Select Unselect
    Ashby's Gap Select Unselect
    Atlanta, Battle of Select Unselect
    Averasboro, Battle of Select Unselect
    Baton Rouge, Battle of Select Unselect
    Belle Grove Select Unselect
    Bentonville, Battle of Select Unselect
    Bentonville, Battle of Select Unselect
    Bermuda Hundred Cpn Select Unselect
    Brice's Crossroads, Battle of Select Unselect
    Bristoe Select Unselect
    Bristoe Select Unselect
    Bull Run, 1st Select Unselect
    Bull Run, 2nd Select Unselect
    Cedar Creek, Battle of Select Unselect
    Chaffin's Farm Select Unselect
    Champions Hill, Battle of (Bakers Creek) Select Unselect
    Chancellorville Select Unselect
    Chattanooga TN Select Unselect
    Chattanooga-Ringgold Campaign Select Unselect
    Chickamaugua, Battle of Select Unselect
    Chickasaw Bayou, Battle of Select Unselect
    Cold Harbor Select Unselect
    Corinth MS, Battle of Select Unselect
    Corinth, Siege of Select Unselect
    Darbytown Road, Battle of Select Unselect
    Deep Bottom I Select Unselect
    Deep Bottom II Select Unselect
    Deep Run OP Select Unselect
    Dinwiddie County House Select Unselect
    Dranesville Select Unselect
    Drewry's Bluff Select Unselect
    Ezra Chapel, Battle of Select Unselect
    Fair Oaks, Battle of Select Unselect
    Fisher's Hill, Battle of (Also Sheridan's Valley Cpn) Select Unselect
    Five Forks Select Unselect
    Fort Bisland, Battle of Select Unselect
    Fort Brady, Repulse of Rebel Fleet Select Unselect
    Fort Dutton, Assualt on Select Unselect
    Fort Fisher, 1st Battle of Select Unselect
    Fort Fisher, 2nd Battle of Select Unselect
    Fort Morgan, Capture of Select Unselect
    Fort Sumter, Battle of Select Unselect
    Franklin, Battle of Select Unselect
    Fredericksburg, Battle of Select Unselect
    Gaines Mill Select Unselect
    Gettysburg Select Unselect
    Glendale, Battle of Select Unselect
    Groveton, Battle of Select Unselect
    Hanover Five Forks, Battle of Select Unselect
    Hatcher's Courthouse, Battle of Select Unselect
    High Bridge Select Unselect
    Hoover's Gap, Battle of Select Unselect
    Jackson, Siege of Select Unselect
    Jenkin's Ferry, Battle of Select Unselect
    Jonesboro, Battle of Select Unselect
    Jonesboro Select Unselect
    Kennesaw Mountain Select Unselect
    Lookout Mountain, Battle of Select Unselect
    Malvern Hill, Battle of Select Unselect
    Manassas, Battle of (Wapping Hgts) Select Unselect
    Maryland Select Unselect
    Mechanicsville, Battle of Select Unselect
    Mill Springs, Battle of Select Unselect
    Mine Run Cpn Select Unselect
    Mine Run Select Unselect
    Missionary Ridge Select Unselect
    Mobile AL (Fort Gaines) Select Unselect
    Nashville Select Unselect
    New Hope Church (also Payne's Farm) Select Unselect
    New Hope Church Select Unselect
    New Madrid OP Select Unselect
    North Anna River (Also Telegraph Road Bridge, Jericho Mill, Ox Ford, Quarles Mill, Hanover Junction) Select Unselect
    North Anna River Select Unselect
    Olustee (Ocean Pond) , Battle of Select Unselect
    Opequon, Battle of (Also Third Winchester) Select Unselect
    Pea Ridge, Battle of Select Unselect
    Peninsula Cpn Select Unselect
    Perryville, Battle of Select Unselect
    Petersburg, Siege of Select Unselect
    Pine Hill, Battle of Select Unselect
    Pleasant Hill, Battle of Select Unselect
    Poplar Springs Churche Select Unselect
    Port Gibson, Battle of Select Unselect
    Prairie Grove, Battle of Select Unselect
    Rappahannock Station Select Unselect
    Raymond, Battle of Select Unselect
    Red River Select Unselect
    Resaca Select Unselect
    Richmond, Battle of Select Unselect
    Ringgold Gap, Battle of Select Unselect
    Rocky Face Ridge, Battle of Select Unselect
    Savannah, Siege of Select Unselect
    Seven Days, Battle of Select Unselect
    Seven Pines, Battle of Select Unselect
    Sharpsburg, Battle of Select Unselect
    Shiloh, Battle of Select Unselect
    Siege of Port Hudson Select Unselect
    Snicker's Gap Select Unselect
    South Mountain, Battle of Select Unselect
    Spanish Fort/Ft Blakely, Battle of Select Unselect
    Spotsylvania Court House Select Unselect
    Spring Hill Select Unselect
    Stirling's Plantation, Battle of Select Unselect
    Stone's River, Battle of Select Unselect
    Teche Campaign Select Unselect
    Totopotomoy (Bethesda Church, Crumps Creek, Matadequin Creek, Shady Grove Road, Hanovertown) Select Unselect
    Vicksburg MS Siege of Select Unselect
    Wauhatchie, Battle of Select Unselect
    Waynesboro, Battle of Select Unselect
    Weldon Railroad, Select Unselect
    Wilderness, Battle of Select Unselect
    Williamsburg, Battle of (Also Ft Magruder, Battle of) Select Unselect
    Winchester, Battle of Select Unselect
    Yazoo Pass (Sherman's) Expedition Select Unselect
    Yorktown, Siege of Select Unselect

    List one or more Battles not listed above...


    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 - $22.45 Full Color Document Only
  • U.S. delivery - $27.45 Full Color Document in Bond Enclosure
  • U.S. delivery - $7.50 Full Color printable PDF Document on CD-Rom (when requesting a minimum of 25 certificates). $8.45 USPS shipping added to total
  • 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 paper-published Certificate (not emailed Certificate) has been requested.)
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No

    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

  • 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

  • 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 (Pacific Time Zone)
    Policy Statements On Display Recognitions and Hardwear
    Personalized items shipped or emailed with a name and SN/PSN number cannot be returned or refunded. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

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