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Vietnam Cross of Gallantry
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. Click the button at the bottom of this completed form to email it to The War Library, along with a copy of your or the veteran's DD-214 (US) or AAx-xxx (Australia) 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 Be Sending.

What Country did you serve for?:

Recipient's LAST Name (as it appears on the Report of Separation):
FIRST Name (as it appears on the Report of Separation):

MIDDLE name (as it appears on the Report of Separation):
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:

VCOG Awarded:
[*] If Unit Award, provide Name of Unit:
DO NOT USE ANY ABBREVIATIONS. PROVIDE THE FULL SPELLING OF UNIT NAMES IN THEIR ENTIRETY

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

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  

    • Is one of the following devices associated to the Vietnam Cross of Gallantry noted on your DD-214 or DD-215?:

    Palm Leaf | Silver Star | Bronze Star | Gold Star

    Month/Day/Year Arrived Vietnam Example: 11/23/1966:
    Month/Day/Year Departed Vietnam Example: 11/07/1967:

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

    • I will mail a Check along with my application and documentation. The Library will receive my envelope within 10 days from today.
    • I will mail a Money Order along with my application and documentation. The Library will receive my envelope within 10 days from today.

    CHARGE or DEBIT CARD applicants:

    -- My current Card information is already on file from a previous Application

    If your Card information is not on file, 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:

    TOTAL ADMIN PROCESSING/DELIVERY:

    I want to purchase the Full Color...

  • PDF emailed (full color, printable) ($7.50) (No shipping fee)
  • Document only ($24.50)
  •    Document only with wallet card ($30.50)
  • Document in Bond Enclosure ($29.50)
  •    Document in Bond Enclosure with wallet card ($35.50)

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

    Would you like to receive the Official, full size Gallantry Cross replacement medal?

  • No, I already have the hardwear
  • Yes, please include the official Medal and add an additional $36.00 to my total

    • Would you like to receive the Official, Gallantry Cross replacement ribbon?

  • No, I already have the ribbon
  • Yes, please include the official ribbon and add an additional $5.00 to my total

    • Would you like to receive the miniature Gallantry Cross replacement medal?

  • No, I already have the miniature
  • Yes, please include the miniature medal and add an additional $25.00 to my total

    • Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?
    (Fee: $3.50) Available only when a published certificate is requested. Not available with emailed certificates.

  • No.
  • Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:

    • Official's name
    Official's Title
    Official's Agency Name (name of unit, vessel, office, school, etc.)
    Address
    City, State, Zip

    International shipping cost (Recipients or family members of recipients living living outside the United States, please add the shipping cost you were quoted... (Allied nations [MACV] of Australia, Canada, New Zealand and South Korea add $27.00)

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

  • No, I will obtain the free jpg copy

  • Yes, please include a Medal Will for a MALE heir of my Awards and add $4.00 to my total
  • Yes, please include a Medal Will for a FEMALE heir of my Awards and add $4.00 to my total

    • 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

    • Your Application Form is now complete. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed or emailed. Non-personalized items such as hardwear may be exchanged or returned within ten days of delivery.

    Records Chief (REC-AMW)
    The American War Library
    817 East Via Carmelitos
    Virginia Building 319
    Long Beach CA 90805-7549
    Phone: 1-562-422-4100 (Pacific Time Zone)

    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..