Phone/Fax: 1-310-532-0634

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 fax 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:
    FIRST Name:
    MIDDLE name:
    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:


    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 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:

    -- 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 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:

  • I would like the following Display Recognition...

  • .PDF Emailed - $9.50 Black & White (No Color)
  • .PDF Emailed - $11.75 Full Color
  • U.S. delivery - $21.25 Full Color Document Only
  • U.S. delivery - $25.75 Full Color Document in Bond Enclosure
  • I want ALL or SOME of my Certificates (minimum 20) in pdf format that I can print continuously, shipped to me on a CD rom that I can make copies of. (Library Note: See below for details)
  • I do not want the Display Recognition. I am requesting the hardware 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 Certificate along with one of the above full-size color Certificates ($3.50) Yes 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
  • I want SOME of my Certificates (minimum 20) in full color; $10.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • I want ALL of my Certificates in Black&White; $8.00 per Certificate
  • I want SOME of my Certificates (minimum 20) in Black&White; $8.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • No CDrom

    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 seventy [.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, faxed or emailed).

    Records Chief (REC-AMW)
    The American War Library
    Building Two, 16907 Brighton Avenue
    Gardena CA 90247-5420
    Phone/Fax: 1 310 532 0634

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