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

Air Force, Army, Coast Guard, Marine, Navy
Military Service Discharge
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail or email this completed form along with a photocopy of your or the veteran's DD-214, WD AGO 53-55, NA Form 13038, 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.

    Select Service Branch:


    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


    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:

    Recipient's Service Number:

    Day, Month and Year Active Duty Military Service Ended

    Replacement Recognition Type your DD-214 will support:


    If you are sending a check or USPS money order please indicate:

    • I will mail a check along with my application and documentation

    • I will mail a USPS money order along with my application and documentation

    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...

    This section for Charge Card and Debit Card applicants. If you are sending a check or USPS money order please skips this section:

    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
  • 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 paper-published Certificate (not emailed Certificate) has been requested.)
    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 ALL of my Certificates in full color; $10.00 per Certificate $10_each"> I want SOME of my Certificates (minimum 20) in full color; $10.00 per Certificate; I will be emailing a list of the 20
  • I want ALL of my Certificates in Black&White; $8.00 per Certificate $10_each"> I want SOME of my Certificates (minimum 20) in Black&White; $8.00 per Certificate; I will be emailing a list of the 20

    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 [.75] cents extra)?

  • Yes, add 75 cents to my total

  • No, I don't want to track my package

  • Ignore this final Question if you will EMAIL or have previously EMAILED a copy your DD-214...

    Would you like your mailed DD-214 scanned by The War Library and integrated into your 201A Award Report that will be emailed to you when your requested item(s) are sent to you? The scanning fee is $3.00 (a one-time fee)

  • Yes, add a one-time $3.00 to my total to Scan and Integrate my DD-214 into my Award Report

  • No, I will accept my Award Report without my DD-214 appearing in the Report


  • 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).

    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)

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