Online Order Form

Aardvark Research Group > Online Order Form

Step 1

Veteran Information

Step 2

Military Service Information

Step 3

return address and signature

Step 4

Method of payment

NAME USED DURING SERVICE (last, first and middle)*

SOCIAL SECURITY NO.*

DATE OF BIRTH (MM/DD/YYYY)*

Phone Number*

Email Address*

Proceed to next Step

MILITARY SERVICE INFORMATION

Service	BRANCH OF SERVICE	YEAR ENTERED	YEAR RELEASED	OFFICER	ENLISTED	SERVICE NUMBER
	DATES OF SERVICE (Please Estimate)				CHECK ONE
	BRANCH OF SERVICE	YEAR ENTERED	YEAR RELEASED	OFFICER	ENLISTED	SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
a. ACTIVE SERVICE
a. ACTIVE SERVICE	a. ACTIVE SERVICE	DATES OF SERVICE (Please Estimate)				BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED	CHECK ONE	OFFICER	OFFICER	ENLISTED	ENLISTED	SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
DATES OF SERVICE (Please Estimate)			BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED		CHECK ONE		OFFICER	ENLISTED		SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
b. RESERVE SERVICE	a. ACTIVE SERVICE
b. RESERVE SERVICE	b. RESERVE SERVICE	DATES OF SERVICE (Please Estimate)				BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED	CHECK ONE	OFFICER	OFFICER	ENLISTED	ENLISTED	SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
DATES OF SERVICE (Please Estimate)				BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED		CHECK ONE	OFFICER	ENLISTED		SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
c. ARMY/AIR NATIONAL GUARD	b. RESERVE SERVICE
c. ARMY/AIR NATIONAL GUARD	c. ARMY/AIR NATIONAL GUARD	DATES OF SERVICE (Please Estimate)				BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED	CHECK ONE	OFFICER	OFFICER	ENLISTED	ENLISTED	SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)
DATES OF SERVICE (Please Estimate)				BRANCH OF SERVICE		YEAR ENTERED		YEAR RELEASED		CHECK ONE	OFFICER	ENLISTED		SERVICE NUMBER (Pre 1970 Only) (if unknown, write “unknown”)

HAVE YOU MADE A PRIOR REQUEST FOR YOUR RECORDS WITHIN THE PAST 90 DAYS?*

Yes No

INFORMATION
INFORMATION AND/OR DOCUMENT REQUESTED
DD Form 214 or equivalent
Other Information and/or documents requested Please Explain:*

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REQUESTER IS:

Military service member or veteran identified in Section I, above

Next of kin of deceased veteran

Legal guardian (must submit copy of court appointment or power of attorney)

PURPOSE * Please choose one of the options below.

Medical Urgent
Employment Urgent
Burial/Funeral
VA Loan
Other


(Please Specify)*

SEND INFORMATION/DOCUMENTS TO:

Name*

Street Address*

Apt.

City*

State*

Zip Code*


Your Signature* (?) Please sign using your mouse. Don't worry about the appearance of the signature--it does not have to be perfect.	Clear Your Signature "Please sign the form by clicking on the signature line with your mouse and moving the blue ball to create a written signature. We cannot process your order without a signature."

Complete and Pay

Choose shipping method *

Express Service (USPS Regular Mail Shipping) $79.00

Priority Express Service (Includes Emailed Copy & USPS Priority Mail Shipping) $99.00

Credit Card Information

Name on Card (First Name)*

Name on Card (Last Name)*

Card Number*

Expiration Month/Year*

I agree to Terms and Conditions

I authorize you to act as my agent to copy and deliver the records I have ordered.