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Coast Guard Order Form

Fill out this form. Then click the "Send" button at the bottom of the page.

You can also order by phone- Toll Free: 1 (866) 447-1011
Please Choose the type of certificate you need:
U. S. Coast Guard Certificate
U. S. Coast Guard Reserve Certificate
Please Choose ONLY One Heading: VETERAN ACTIVE  RESERVE RETIRED
Your Name:
Name on Certificate - if different:
We may have to contact you with questions about your certificate. Please give us the your contact information.
Address:
City: State: Zip:
Telephone Number:
E-Mail Address :
Rank and specialty mark:
Wars or Operations, If Served:
Service From/Since: and/or To:
Medals/Ribbons

Up to TWELVE photo images of your medals can be placed on your certificate at $5.00 ea.
Devices are $1.00 ea.

PLEASE LIST THEM IN ORDER OF IMPORTANCE
There are hundreds, so list the specific, complete name of each one, how many devices and what they are. (stars, oak leaves, etc.)
Medal #1 Devices:
Medal #2 Devices:
Medal #3 Devices:
Medal #4 Devices:
Medal #5 Devices:
Medal #6 Devices:
Medal #7 Devices:
Medal #8 Devices:
Medal #9 Devices:
Medal #10 Devices:
Medal #11 Devices:
Medal #12 Devices:

Up to EIGHT photo images of your ribbons can be placed on your certificate at $5.00 ea.
However, if you have a LOT of text, we may not be able to fit all eight.
We will try to fit as much info. as we can. Devices are an additional $1.00 ea.
Ribbon #1 Devices:
Ribbon #2 Devices:
Ribbon #3 Devices:
Ribbon #4 Devices:
Ribbon #5 Devices:
Ribbon #6 Devices:
Ribbon #7 Devices:
Ribbon #8 Devices:
Up to THREE photo images of your wings or badges, or patch/emblems
can be placed on your certificate at $5.00 ea. This too, depends on space available.
Badge #1    
Badge #2    
Badge #3    
       
Military Badges Available Are: If not listed here just ask.
Military Freefall
Parachutists
Combat Crew
Combat Aircrew
Wings
Ordnance Disposal
Explosive Ordnance 		Explosive Ordnance Disposal
Combat Infantryman
Expert Infantryman
Combat Medical
Army Driver-Mechanic
Diver
Army Pathfinder
 Expert Medical
Aviation Observer
Scuba Diver
Army Ranger
Presidential Service
Other badges are also available. If you need one that is not listed you can e-mail us or give us a call TOLL FREE at 1-(866) 447-1011 (9:00 a.m - 5:00 p.m. West Coast Time)
Wallet Size Copies of Your Certificate are also available for $17.00 each.
Please Check if you would like one:
......Your original certificate must be made first in order to make the wallet size copy.
Your Certificate may be placed on a Cherry Wood Plaque with Classy Gold Border for $44.00 each.
Please Check if you would like one:

Special or Additional Information:

Click once; please wait for the payment page. Thank you for your patience.

For questions, price quotes or if
you prefer to pay by check or money order,
Please call Toll Free: 1 (866) 447-1011

Satisfaction Guaranteed
CJM Military Certificates
704 N. Easy Street #1
Payson, Arizona 85541
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