Questions About This Form? Use Email

Phone: 1-562-422-4100

USARV and or MACV Service Acknowledgement
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full. ( Click here to email amerwar@amervets.com if you have any technical problems sending this Application Form after you have completed it )

    2. Print and mail or email this completed form, along with a copy of your or the veteran's DD-214, WD AGO 53-55, NAVPERS 553, NGB 22, or other pre-arranged military document(s) to the address below.

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The DD-214
    Or Other Military Document Photocopy
    You Will Mail.

    Charge card or Debit card applicants: To expedite shipment of your Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

    Display Type:

    Recipient's LAST Name:
    FIRST Name:
    MIDDLE name:
    Title (Must appear on military documentation):Jr Sr II III IV

    Is this veteran currently living, deceased or KIA:
      LIVING
      DECEASED
      KILLED IN ACTION

    Service Branch:

    Rank Title (Please Do Not Abbreviate):

    Paygrade
    Enlisted
    Warrant
    Officer

    I have not moved. My current address info is on file from a previous application

    Street Address:

    City:
    State:
    ZipCode:
    Phone (NO SPACES OR DASHES):

    Your full and complete contact email address:

    SERVICE NUMBER:

  • Enter the veteran's FIRST FOUR DIGITS ONLY (Do Not enter any alphabet letters. Numbers only.) 
  • Enter the SECOND FOUR (or remaining) DIGITS ONLY  

    • Date Arrived Southeast Asia Territory:
    Date Departed Southeast Asia Territory:

    UNIT / VESSEL INFORMATION

    The name/number of your Company or Vessel:

    If your unit was part of a Battalion what is the name/number of your Battalion:

    If your unit was part of a Regiment what is the name/number of your Regiment:

    If your unit was part of a Brigade or Air Group what is the name/number of your Brigade or Group:

    If your unit was part of a Division or Air Wing what is the name/number of your Division or Wing:

    If you are sending a Check or Money Order please indicate:

    • I will mail a Check along with my application and documentation
    • I will mail a Money Order along with my application and documentation

    Charge or Debit Card applicants, please complete the following:

    Your Name as it appears on your charge or check debit card:

    Payment Method
      Check Debit
      Visa
      MasterCard
      American Express
      Discover
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    After printing this form for mailing, please sign here:

    International shipping cost (U.S. veteran living outside the United States, please add the shipping cost you were quoted...

    TOTAL ADMIN PROCESSING/DELIVERY:

    I want to purchase the Full Color...

  • PDF emailed (full color, printable) ($7.50) (No shipping fee)
  • Document shipped ($24.77)...
       Document only with wallet card ($30.77)
  • Document shipped in Bond Enclosure ($29.77)...
       Document in Bond Enclosure with wallet card ($35.77)

    • (The shipping totals above include the USPS - Priority Mail shipping fee)

    Would you like to receive the official, full size USARV and/or MACV (color) Patch

  • Yes, please include the official MACV patch and add an additional $5.90 to my total
  • Yes, please include the official USARV patch and add an additional $5.90 to my total
  • Yes, please include both the official USARV and MACV patches and add an additional $11.80 to my total
  • No, I already have the patch(es)

  • I do not want the Display Recognition. I am requesting the hardware items listed below (medal, badge, ribbon or patch) if they are available for this award. (Shipping cost applies to non-certificate requests.)

    • Would you like a published copy of My Military Medal Last Will And Testament?

  • Yes, please include a Medal Will for a male heir of my medals and add $4.00 to my total
  • Yes, please include a Medal Will for a female heir of my medals and add $4.00 to my total
  • No, I will obtain the free jpg copy

    • Would you like to track your package through the United States Post Office after it has been shipped (for twenty [.20] cents extra)?

  • Yes, add 20 cents to my total
  • No, I don't want to track my package

    • Click Here if you are a Prior Applicant who's DD-214 is on file
    New Applicants Click Here

    Your Application Form is now complete. Print, Sign and Mail this completed form to the address below along with the required military-issued Report of Separation or other (pre-approved) document(s). You may (OPTIONAL) email this form for faster processing. However, you must still mail or email a copy of your military document(s).

LINK: Policy Statements On Display Recognitions and Hardwear
Name-personalized items that are produced uniquely for a recipient may not be exchanged or returned. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

Print a copy for yourself before clicking the bar below..