Phone/Fax: 1-310-532-0634

Military Spouse
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 the required document(s) described on the Instruction Page, or other pre-arranged 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.

    Charge card or Debit card applicants: To expedite shipment of your Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

    Recipient's LAST Name:
    FIRST Name:
    MIDDLE name:

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Spouse's Name:

    Spouse's Highest Rank/Rate (Please do not abbreviate):

    Spouse's Service Number:

    Spouse's Service Branch:
    Air Force
    Army
    Coast Guard
    Marine Corps
    Navy

    Years of Spouse's Military Service:
    Year Entered Military Service:
    Year Ended Military Service:

    Date of Marriage:
    Day:
    Month:
    Year

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, please complete the following:

Please choose between ASAP or Monthly shipping...

  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped As Soon As Possible.
  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped in monthly groups of...

      Ship 1 of my Application Forms per month
      Ship 2 of my Application Forms per month
      Ship 3 of my Application Forms per month
      Ship 4 of my Application Forms per month

    Bill my charge/debit card and send me an email receipt between the 1st and 5th day of each month for each shipment. Please note that I am using a credit/debit card that will not expire before all of my monthly shipments have been sent to me.

    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

    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 - $9.50 Black & White (No Color)
  • U.S. delivery - $21.20 Document Only
  • U.S. delivery - Bond Enclosure $25.70
    Navy
    Regal
    Black
    Military Standard Issue
  • U.S. delivery - EnDurable Frame, Acrylic Black, $32.70

    • Would you like to track your package through the United States Post Office after it has been shipped (for seventy [.70] cents extra)?

  • Yes, add 70 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 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 fax a copy of your military document(s).

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