Custom Fields Form

Please fill out this form and click submit when you are finished to proceed with the creation of your county’s Honor Rewards page.

In the “Required” section, please check the fields you want to make mandatory for users trying to sign up for a Honor Rewards card.

In the “Optional” section, please check the fields you want to make available for users to fill in, but they are not required to receive an Honor Rewards card.

If you have additional fields you’d like to have on your county’s page, please let us know in the “Other Fields” section.


		
		
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
          Your County (Name and State) *
Required:
Name
Address
Email
Branch of Service
Years of Service
Military Discharge Number
County Discharge Recorded In
Photo
Date of Birth
Phone
Optional:
Name
Address
Email
Branch of Service
Years of Service
Military Discharge Number
County Discharge Recorded In
Photo
Date of Birth
Phone
Other fields:
(Please specify if the additional fields are required or optional for the user)
ID Card Printing Process: *
County validates all requests before sending to print
Fidlar can automatically print a card for every request received
If you chose to have your county validate all submissions, what email address do you want the submissions to go to?
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