new order

USE THIS PAGE AS THE COVER SHEET
BE SURE TO SIGN THE FIRST PAGE

Paying by Check? Attach a copy of the check below.

YOU MUST MAIL THE CHECK AS WELL
Did you fax Form
Yes No
# faxed from

Did you mail Form
Yes No
Date Mailed

Did you email Form
Yes No
Email Address Sent by

Paid online
Yes No
Email Address used for Payment

Paid Check
Yes No
Name on Check

Document Ordered
Priority DD214 $85.00 Funeral DD214 $85.00
Priority 201 File $169.00 OTHER______________________________________
FAX TO 1 (314) 754-9690
Tel. 703 560 3922
MAIL TO LYON RESEARCH
P.O. BOX 645
Dunn Loring, VA 22027-0645
Amount Paid

Date Paid

Attach copy of Check HERE

Be sure to Mail the Check!!
SIGN THE ORDER FORM

USE THIS PAGE AS THE COVER SHEET BE SURE TO SIGN THE FIRST PAGE Paying by Check? Attach a copy of the check below. YOU MUST MAIL THE CHECK AS WELL
Did you fax Form	Yes No	# faxed from
Did you mail Form	Yes No	Date Mailed
Did you email Form	Yes No	Email Address Sent by
Paid online	Yes No	Email Address used for Payment
Paid Check	Yes No	Name on Check
Document Ordered Priority DD214 $85.00 Funeral DD214 $85.00 Priority 201 File $169.00 OTHER______________________________________
FAX TO 1 (314) 754-9690 Tel. 703 560 3922			MAIL TO LYON RESEARCH P.O. BOX 645 Dunn Loring, VA 22027-0645
Amount Paid		Date Paid
Attach copy of Check HERE Be sure to Mail the Check!! SIGN THE ORDER FORM