Phone: 1-562-422-4100

The "Ruptured Duck"
Honorable Discharge Lapel Pin

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, WD AGO 53-55, NA Form 13038, NAVPERS 553, NGB 22, or you can Print and mail this form and the required documents to the Library's mailing 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:
    FIRST Name:
    MIDDLE name:
    Title (Must appear on military documentation):Jr Sr II III IV

    Rank Title (Please Do Not Abbreviate):

    Service Branch:

    Date Entered Service:

    Date Discharged:

    Service Number:


    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:


    If you are sending a check or 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 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...

    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 Choose one of the following...:

  • U.S. delivery - $15.35 Lapel Pin Only ($8.00) + $7.35 USPS shipping)

  • .PDF Emailed - $7.50 Full Color Certificate Only (by email)

    The Lapel Pin is $5.00 less when obtained with the Certificate

  • U.S. delivery - $22.35 Full Color Certificate Only ($14.00 + $8.35 USPS shipping)

  • U.S. delivery - $25.35 Full Color Certificate ($14.00) and Lapel Pin ($3.00) + $8.35 USPS shipping

  • U.S. delivery - $27.35 Full Color Certificate ($19.00) in Bond Enclosure Only + $8.35 USPS shipping

  • U.S. delivery - $30.35 Full Color Certificate ($19.00) in Bond Enclosure and Lapel Pin ($3.00) + $8.35 USPS shipping


  • 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 Certificate is requested now or previously.)
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No

    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 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-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
    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..