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Vietnam Service Medal
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, or you can Print and mail this form along with a copy of the DD-214, WD AGO 53-55, NAVPERS 553, NGB or other pre-arranged documents to the Library's mailing 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.

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:

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  

    • 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 Wind:

    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:

    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 ($24.50)...
         Document only with wallet card ($30.50)
    • Document shipped 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 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

      Would you like to order the Official, full size Vietnam War replacement medal and/or ribbon?

    • No, I already have the hardwear
    • Yes, please include the official medal and add an additional $17.00 to my total
    • Yes, please include the official ribbon and add an additional $4.00 to my total
    • Yes, please include the official medal and the ribbon, and add an additional $21.00 to my total

      • Campaign Star Attachment

    • Yes, please include the 1 Bronze Star attachment to the medal and/or ribbon and add an additional $3.00 (or $6.00 for both medal and ribbon) to my total
    • Yes, please include the 2 Bronze Star attachment to the medal and/or ribbon and add an additional $3.00 (or $6.00 for both medal and ribbon) to my total
    • Yes, please include the 3 Bronze Star attachment to the medal and/or ribbon and add an additional $3.00 (or $6.00 for both medal and ribbon) to my total
    • Yes, please include the 4 Bronze Star attachment to the medal and/or ribbon and add an additional $3.00 (or $6.00 for both medal and ribbon) to my total

      • Would you like to receive the full size Cold War Victory Commemorative medal and ribbon?

    • Yes, please include the Cold War medal and ribbon set, add an additional $64.00 to my total.
    • No, I already have the Cold War hardwear.

      • Would you like to receive the Miniature Vietnam Service medal?

    • Yes, please include the Miniature medal and add an additional $10.50 to my total.
    • No, I already have the hardwear.

      • 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..