Phone/Fax: 1-310-532-0634

Vietnam Cross of Gallantry
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail or fax this completed form, 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 Mark Your DD-214
    or Other Military Document!!!

    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).

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

    Service Branch:

    VCOG Awarded:
    [*] If Unit Award, provide Name of Unit:

    Rank Title (Please Do Not Abbreviate):

    Paygrade
    Enlisted
    Warrant
    Officer

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Recipient's Service Number:

    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

    Date Arrived Vietnam:
    Date Departed Vietnam:

    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
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date

    After printing this form for mailing, please sign here:

    Processing/Delivery:

  • U.S. delivery - Bond Enclosure $25.60
    Navy
    Regal
    Black
    Military Standard Issue
  • U.S. delivery - EnDurable Frame, Acrylic Brown, $27.60
  • U.S. delivery - EnDurable Frame, Acrylic Black, $27.60
  • U.S. delivery - Gold Color Frame, $32.60 Gold
  • I do not want the Display Recognition. I am requesting the hardware items (medal, badge, ribbon or patch) if they are available for this award, below. (Additional shipping cost applies to non-certificate requests.)

    • 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 to receive the Official, full size Gallantry Cross replacement medal or replacement ribbon?

  • No, I already have the hardware

  • Yes, please include the official medal and add an additional $17.50 to my total

  • Yes, please include the official ribbon and add an additional $5.00 to my total

  • Yes, please include both the official medal and ribbon and add an additional $22.50 to my total

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

  • Yes, please include the miniature medal and add an additional $15.00 to my total

  • No, I already have the miniature

    • 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 sixty-five [.65] cents extra)?

    • Yes, add 65 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 fax a copy of your military document(s).

      Records Chief (REC-AMW)
      The American War Library
      Building Two, 16907 Brighton Avenue
      Gardena CA 90247-5420
      Phone/Fax: 1 310 532 0634