Vietnam Cross of Gallantry
Replacement Recognition Application Form
New Zealand

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail this completed form, along with a copy of your Certificate of Service or other pre-arranged military document(s) to the address below.

    Do Not Mark Your Certificate of Service
    or Other Military Document!!!

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The Certificate of Service
    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 Certificate of Service 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):

    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 Certificate of Service 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:

    Please choose between ASAP or Monthly shipping...

  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped As Soon As Possible.
  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped in monthly groups of...

      Ship 1 of my Application Forms per month
      Ship 2 of my Application Forms per month
      Ship 3 of my Application Forms per month
      Ship 4 of my Application Forms per month

    Bill my charge/debit card and send me an email receipt between the 1st and 5th day of each month for each shipment. Please note that I am using a credit/debit card that will not expire before all of my monthly shipments have been sent to me.

    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:

    TOTAL ADMIN PROCESSING/DELIVERY:

  • I would like the following Display Recognition...
  • .PDF Emailed - $9.50 Black & White (No Color)
  • U.S. delivery - $21.20 Full Color Document Only
  • U.S. delivery - $25.70 Full Color Document in Bond Enclosure
  • I want ALL or SOME of my Certificates (minimum 20) in pdf format that I can print continuously, shipped to me on a CD rom that I can make copies of. (Library Note: See below for details)
  • 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 the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No
    I want Certificates in pdf format on a CD rom...

  • I want ALL of my Certificates in full color; $10.00 per Certificate
  • I want SOME of my Certificates (minimum 20) in full color; $10.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • I want ALL of my Certificates in Black&White; $8.00 per Certificate
  • I want SOME of my Certificates (minimum 20) in Black&White; $8.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • No CDrom

    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)

  • 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

    Shipping cost to New Zealand is: $27.00US

    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

    • You will shortly receive a confirmation email/receipt acknowledging your application arrived, or should we have a question or require more information. Please ensure that you have entered a correct email address.

    To email this form click the button below. To mail this form address your envelope to:

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