Civil War Combat Campaign Service Recognition Replacement Application Form

Questions About This Form? Use Email
Phone: 1-562-422-4100 (Pacific Time Zone)

Civil War Combat Campaign Service
Replacement Recognition Application Form

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 (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 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

Is this veteran currently living, deceased or KIA:
  LIVING
  DECEASED
  KILLED IN ACTION

Service Branch:

Rank Title (Please Do Not Abbreviate):

I have not moved. My current address info is on file from a previous application

Address:
City:
State:
ZipCode:
Phone (NO SPACES OR DASHES):

Your full and complete contact email address:

SERVICE NUMBER:
(Do Not enter any alphabet letters. Numbers only.)
★ Enter the veteran's 1st FOUR DIGITS ONLY  ☛
★ Enter the 2nd FOUR (or remaining) DIGITS ONLY   ☛

Date Entered Military Svc
Date Discharged

I am Selecting ONLY ONE campaign credit certificate
I am Selecting MORE THAN ONE campaign credit certificate
Allatoona, Battle of Select Unselect
Antietam Select Unselect
Appamattox Cpn Select Unselect
Appomatox Campaign Select Unselect
Appomatox Court House Surrender Select Unselect
Arkansas Post (Fort Hindman), Battle of Select Unselect
Ashby's Gap Select Unselect
Atlanta, Battle of Select Unselect
Averasboro, Battle of Select Unselect
Baton Rouge, Battle of Select Unselect
Belle Grove Select Unselect
Bentonville, Battle of Select Unselect
Bentonville, Battle of Select Unselect
Bermuda Hundred Cpn Select Unselect
Brice's Crossroads, Battle of Select Unselect
Bristoe Select Unselect
Bristoe Select Unselect
Bull Run, 1st Select Unselect
Bull Run, 2nd Select Unselect
Cedar Creek, Battle of Select Unselect
Chaffin's Farm Select Unselect
Champions Hill, Battle of (Bakers Creek) Select Unselect
Chancellorville Select Unselect
Chattanooga TN Select Unselect
Chattanooga-Ringgold Campaign Select Unselect
Chickamaugua, Battle of Select Unselect
Chickasaw Bayou, Battle of Select Unselect
Cold Harbor Select Unselect
Corinth MS, Battle of Select Unselect
Corinth, Siege of Select Unselect
Darbytown Road, Battle of Select Unselect
Deep Bottom I Select Unselect
Deep Bottom II Select Unselect
Deep Run OP Select Unselect
Dinwiddie County House Select Unselect
Dranesville Select Unselect
Drewry's Bluff Select Unselect
Ezra Chapel, Battle of Select Unselect
Fair Oaks, Battle of Select Unselect
Fisher's Hill, Battle of (Also Sheridan's Valley Cpn) Select Unselect
Five Forks Select Unselect
Fort Bisland, Battle of Select Unselect
Fort Brady, Repulse of Rebel Fleet Select Unselect
Fort Dutton, Assualt on Select Unselect
Fort Fisher, 1st Battle of Select Unselect
Fort Fisher, 2nd Battle of Select Unselect
Fort Morgan, Capture of Select Unselect
Fort Sumter, Battle of Select Unselect
Franklin, Battle of Select Unselect
Fredericksburg, Battle of Select Unselect
Gaines Mill Select Unselect
Gettysburg Select Unselect
Glendale, Battle of Select Unselect
Groveton, Battle of Select Unselect
Hanover Five Forks, Battle of Select Unselect
Hatcher's Courthouse, Battle of Select Unselect
High Bridge Select Unselect
Hoover's Gap, Battle of Select Unselect
Jackson, Siege of Select Unselect
Jenkin's Ferry, Battle of Select Unselect
Jonesboro, Battle of Select Unselect
Jonesboro Select Unselect
Kennesaw Mountain Select Unselect
Lookout Mountain, Battle of Select Unselect
Malvern Hill, Battle of Select Unselect
Manassas, Battle of (Wapping Hgts) Select Unselect
Maryland Select Unselect
Mechanicsville, Battle of Select Unselect
Mill Springs, Battle of Select Unselect
Mine Run Cpn Select Unselect
Mine Run Select Unselect
Missionary Ridge Select Unselect
Mobile AL (Fort Gaines) Select Unselect
Nashville Select Unselect
New Hope Church (also Payne's Farm) Select Unselect
New Hope Church Select Unselect
New Madrid OP Select Unselect
North Anna River (Also Telegraph Road Bridge, Jericho Mill, Ox Ford, Quarles Mill, Hanover Junction) Select Unselect
North Anna River Select Unselect
Olustee (Ocean Pond) , Battle of Select Unselect
Opequon, Battle of (Also Third Winchester) Select Unselect
Pea Ridge, Battle of Select Unselect
Peninsula Cpn Select Unselect
Perryville, Battle of Select Unselect
Petersburg, Siege of Select Unselect
Pine Hill, Battle of Select Unselect
Pleasant Hill, Battle of Select Unselect
Poplar Springs Churche Select Unselect
Port Gibson, Battle of Select Unselect
Prairie Grove, Battle of Select Unselect
Rappahannock Station Select Unselect
Raymond, Battle of Select Unselect
Red River Select Unselect
Resaca Select Unselect
Richmond, Battle of Select Unselect
Ringgold Gap, Battle of Select Unselect
Rocky Face Ridge, Battle of Select Unselect
Savannah, Siege of Select Unselect
Seven Days, Battle of Select Unselect
Seven Pines, Battle of Select Unselect
Sharpsburg, Battle of Select Unselect
Shiloh, Battle of Select Unselect
Siege of Port Hudson Select Unselect
Snicker's Gap Select Unselect
South Mountain, Battle of Select Unselect
Spanish Fort/Ft Blakely, Battle of Select Unselect
Spotsylvania Court House Select Unselect
Spring Hill Select Unselect
Stirling's Plantation, Battle of Select Unselect
Stone's River, Battle of Select Unselect
Teche Campaign Select Unselect
Totopotomoy (Bethesda Church, Crumps Creek, Matadequin Creek, Shady Grove Road, Hanovertown) Select Unselect
Vicksburg MS Siege of Select Unselect
Wauhatchie, Battle of Select Unselect
Waynesboro, Battle of Select Unselect
Weldon Railroad, Select Unselect
Wilderness, Battle of Select Unselect
Williamsburg, Battle of (Also Ft Magruder, Battle of) Select Unselect
Winchester, Battle of Select Unselect
Yazoo Pass (Sherman's) Expedition Select Unselect
Yorktown, Siege of Select Unselect

List one or more Battles not listed above...

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...

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 want to purchase the Full Color...

PDF emailed (full color, printable) ($7.50) (No shipping fee)
Document shipped ($26.11)...
   Document only with wallet card ($32.11)
Document shipped in Bond Enclosure ($31.11)...
   Document in Bond Enclosure with wallet card ($37.11)

(The shipping totals above include the USPS - Priority Mail shipping fee)

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

Would you like to track your package using the internet through the United States Post Office after it has been shipped (for twenty [.20] cents extra)?
Yes, add 20 cents to my total

No, I don't want to track my package

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.

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)

LINK: Policy Statements On Display Recognitions and Hardwear
Name-personalized items that are produced uniquely for a recipient may not be exchanged or returned. 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..

Please lower your mouse then wait a moment for your info to be logged.

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