U.S. Veteran Compensation Programs
PLEASE TYPE or PRINT VETERAN ID CARD ORDER FORM
IDENTIFICATION INFORMATION
Name (first, middle, last):
Address:
City: State: Zip:
Telephone:
E-mail:
Military Branch:
Date of Birth (mm/dd/yyyy): SSN Last 4: Male Female
Check All That Apply
Discharge Honorable General Under Dishonorable
Type: Honorable
Conditions
Check All That Apply
Air Force Cross Distinguished Flying Cross Navy & Marine Corps Soldier’s Medal
Medal
Airman’s Medal Distinguished Service Navy Cross No Special Recognition
Cross
Bronze Star Distinguished Service POW
Medal
Coast Guard Medal Legion of Merit Purple Heart
Defense Superior Medal of Honor Silver Star
Service Medal
Current Compensation Rating (Check all that apply)
10% 20% 30% 40% 50% 60%
70% 80% 90% 100% No Rating
Special Medical Instructions/Diagnosis:
Check here if you want USVCP to release your information for Verification of your Military Service.
PAYMENT INFORMATION
Credit Card:_____Master Card_____Visa_____Discover_____American Express
No.:
Security No. (back of card): Expiration Date(mm/yyyy):
Signature: Date:
Note: Credit card information processed through parent company - Aspyre Media. Your card will be charged a one time amount of
$11.99 (Veteran ID Card w/o Picture) or $12.99 (Veteran ID Card with picture).
Make Check or Money Order Payable To:
Aspyre Media
Mail To: U.S. Veteran Compensation Programs, P.O. Box 420128, Dept. H1, Houston, TX 77242-0128
Note: Please enclose copy of your DD Form 214. Order Forms received without DD Form 214 will not be processed. We must
have your DD Form 214 to verify military service. When ordering Veteran ID Card with picture, enclose your picture. Do not send
any picture that cannot fit neatly inside a standard size 10 envelope. Any picture you enclose will be returned to you with your
Veteran ID Card.
USVCP Form 1299 Rev. August 2011