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Vietnam Service Medal, New Zealand
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. 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 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 (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):


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

Street Address:

Extended Address:

City:
State:
Code:
Phone:

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  

  • Month and Year Arrived Southeast Asia Territory:

    Month and Year Departed Southeast Asia Territory:


    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
      Discover
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date

    After printing this form for mailing, please sign here:

    Total Admin Processing/Delivery:

  • .PDF Emailed - $9.50 Black & White (No Color)
  • U.S. delivery - $21.10 Document Only
  • U.S. delivery - Bond Enclosure $19.00 plus $27.00 shipping Navy Regal Black
  • U.S. delivery - EnDurable Frame, Acrylic face $19.00 plus $27.00 shipping Brown Black
  • U.S. delivery - Gold Color Frame $24.00 plus $27.00 shipping Gold
  • U.S. delivery - Packaged to be framed by me $19.00 plus $27.00 shipping Unframed

  • 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 1-562-422-4100 (Pacific Time Zone)