Vietnam Service Medal, Australia
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail this completed form, along with a copy of the veteran's Certificate of Service to the address below.

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

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The Certificate of Service
    Or Other Military Document Photocopy
    You Will Be Sending.

    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 (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):


    I have not moved. My current address info is on file from a previous application

    Address:

    Extended Address:

    City:
    State:
    Code:
    Phone:


    Full and complete contact email address:

    Please enter the FIRST EIGHT DIGITS ONLY of the Recipient's Service Number:

    Month and Year Arrived Southeast Asia Territory:

    Month and Year Departed Southeast Asia Territory:


    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

    After printing this form for mailing, please sign here:

    Total Admin Processing/Delivery:

  • .PDF Emailed - $7.50 Full Color
  • U.S. delivery - $22.35 Full Color Document Only
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure

    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
    817 East Via Carmelitos
    Virginia Building 319Long Beach CA 90805-7549PHONE/FAX 1-562-422-4100

Print a copy for yourself before clicking the bar below..