Extinct Military Patches No Longer Manufactured Application Form
Charge card or Debit card applicants: To expedite shipment of your Patch and/or Replacement Recognition you may email this form today.
WHICH PATCH DO YOU WISH (USPS Shipping fee to all 50 US States is included)
1. Complete this form in full. 2. Print then email the completed form by clicking the button, below... or mail the completed form to the address below.
UNIT MEMBER'S LAST Name:
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
Rank Title (Please Do Not Abbreviate):
Phone (NO SPACES OR DASHES):
Full and complete contact email address:
Enter the veteran's FIRST FOUR DIGITS ONLY(Do Not Enter any Alpha characters. Digits only.)
Enter the SECOND FOUR (or remaining) DIGITS ONLY
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, please complete the following:
Your Name as it appears on your charge or check debit card:
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:
Would you also like the Display Recognition...
.PDF Emailed - $9.50 Black & White (No Color)
U.S. delivery - $14.50 Full Color Document Only
U.S. delivery - $19.00 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 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
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
Your Application Form is now complete. After clicking the grey-bar 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..
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