Please complete the form below.
If you do not wish to provide your credit card information online, then leave those fields blank and click submit and print, then hand-write your information on the printed copy and mail it to:

City of Chino Hills
Attn: Neighborhood Services / Military Recognition Banner Program
14000 City Center Drive
Chino Hills, CA 91709

Please note that the rank of the service person will not be used.

Military Service Person

First Name:*

Last Name:*

Branch of Military Service:*

U.S. Army U.S. Air Force U.S. Navy U.S. Coast Guard U.S. Marine Corps

Date of Enlistment: xx/xx/xxxx*

Anticipated Date of Discharge: xx/xx/xxxx*

Name and Address of Contact Person:

Name (First & Last):*

Address:*

City*

State*

Zip Code*

Phone*

E-mail Address:

Relationship to Service Person:*

Method of Payment:

How will you pay for the banner?*

Credit Card

Check made Payable to: City of Chino Hills

If paying by Credit Card, Neigborhood Services Coordinator, Kelly Baas will contact you to arrange for payment or you can call (909) 364-2730.

A 5x7 or larger color photograph must be provided. The photograph must be of the service person in uniform. You can mail the photograph to:

City of Chino Hills, Attn: Neigborhood Services / Military Recognition Banner Program, 14000 City Center Drive, Chino Hills, CA, 91709.

A 5x7 digital jpeg can be emailed to publicworks@chinohills.org (type "Military Banner and the Name of the Service Person" in the subject line), or upload the photo using this online form.

I will provide a photograph by:*

Mail (5x7 Color Photo) Email (300 dpi 5x7 jpeg)

Upload photo now

Choose photo to upload.

Please note that we cannot process your banner order until payment and a color photograph is received. City staff will contact you to arrange for credit card payment. Once both payment and photograph is processed, you will receive confirmation of your completed order.