DD 214 Order Form
Fax to (512) 331-8222
Form is not sent online... it must be faxed or mailed.
Name Used During Service:
  First name Middle name Last name
Social Security Number

Birth Date

County of Birth:
City of Birth:
State:
Service Past and Present ( For an effective search it is important that All Service be shown below. )
Dates of Service Check One
Branch of Servive Date Entered Date Released Officer Enlisted Service Number
Active Service
Reserve Service
National Guard

Branch Current Status of Service Member

Airforce
Coast Guard
Marine Corps

Army
Navy


Is this person deceased?		 If Yes Enter Date of Death

Is (was) this person retired from Military Service?






Information and Documents Requested

Choose which document you require:
 Years Requested:

Other information or documents requested:

Purpose (optional):

Requestor is:
Number of Copies:

Relation to Veteran if deceased:

Specify Person if Other is choosen above:


DELIVERY INFORMATION

First name: Last name:

Mailing Address: *

Apartment No:

City: State: Zip:

Tel: E-mail:

I declare ( or certify verify or state ) under penalty of perjury under the laws
of the United States of America that the informatiom on requester and authorization
to this document is true and correct

Signature:_________________________________ Date:

Total $25.00
Credit Card Number: Expires


Credit Card Billing Information

Name on Credit Card ________________________________

Credit Card Billing Address

_________________________________________________

City_____________________State________Zip__________

Credit Card Holders Signiture_________________________

I authorize US Vital Documents or their representative to obtain this dd214.
I have read and understand the fees listed below.

US Vital Documents can not control the process time by government agencies.
Rush orders are sent via overnight courier with a return overnight envelope.
*You must list a physical street address for Rush deliveries (no APO's, FPO's, or P.O. Boxes)

   
Our Fee:
$25.00
 
 
All Sales Final, Process times may vary based on workload of processing agencies.
I understand that US Vital Documents is not responsible for any service
performed by any overnight courier service or government agency. I understand that US Vital Documents can not control
the process time by government agencies.