Bronze Star Medal Replacement Recognition Application Form
INSTRUCTIONS:
1. Complete this form in full. 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
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:
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
Theater of Operations:
Date (Month and Year) of award eligibility/activity performed:
Does your document indicate the Combat "V":
Yes, Combat V for Valor was awarded. (The V device will appear on the Recognition replacement.)
No, Combat V was not awarded
The name of your Vessel or Unit:
If you are sending a check or USPS 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 USPS 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
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...
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 ($26.11)... Document only with wallet card ($32.11)
Document shipped in Bond Enclosure ($31.11)... Document in Bond Enclosure with wallet card ($37.11)
(The shipping totals above include the USPS - Priority Mail shipping fee)
Would you like the Bronze Star lapel pin ($5.00) Yes No
Would you like the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($6.00) Yes No
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: $3.77)
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 Bronze Star replacement medal and/or ribbon?
No, I already have the hardwear
Yes, please include the official medal and add an additional $20.00 to my total
Yes, please include the official ribbon and add an additional $2.50 to my total
Yes, please include the official medal and the ribbon and add an additional $22.50 to my total
"V" for Valor Device
Yes, please include the "V" Device attachment to the medal and/or ribbon and add an additional $3.00 (or $6.00 for both medal and ribbon; or $9.00 for medal, ribbon and mini) to my total
Would you like to receive the Miniature Bronze Star medal?
Yes, please include the Miniature medal and add an additional $15.50 to my total.
No, I already have the hardwear.
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
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. 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).
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..
Please lower your mouse then wait a moment for your info to be logged.
Check Debit
American Express: 4 digits on front of card
All other cards, 3 digits on back