Phone: 1-562-422-4100

Fulfillment of Military Service
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 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 (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):

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Please enter the FIRST EIGHT DIGITS ONLY of the Recipient's Service Number:

    Day, Month and Year Entered Military Service

    Day, Month and Year Military Service Obligation Completed

    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...

    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:

  • U.S. delivery - $22.35 Full Color Document Only
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure
  • 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
    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 of my Certificates (minimum 20) in full color; $7.50 per Certificate on CD-ROM. I will be emailing a list of the Certificates I want

  • No CDrom

    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?

  • 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-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. Print, Sign and Mail or Email 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 email 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
    Policy Statements On Display Recognitions and Hardwear