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About You

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City ZIP Code

Email Address(Required)

Email Address Confirm Email Address

Phone(Required)

DOB(Required)

MM slash DD slash YYYY

Last 4 Digits of Social Security Number(Required)

Please enter a number from 1000 to 9999.

Branch of Service(Required)

Navy

Army

Air Force

Marine Corp

Coast Guard

Rate OR MOS(Required)

Date of Entry(Required)

MM slash DD slash YYYY

If you do not know the day, please choose the 1st of the month.

Date of Discharge(Required)

MM slash DD slash YYYY

If you do not know the day, please choose the 1st of the month.

Discharge Characterization(Required)

Honorable

General Under Honorable

Other Than Honorable

Administrative Separation

Bad Conduct Discharge

Dishonorable Discharge

Medical Discharge

Rank at Discharge(Required)

If different, highest rank achieved.

List all Duty Stations and Deployments(Required)

How Can We Reach You?

We would love to talk with you. How can we get in touch?

Preferred Method of Contact(Required)

Upload DD-214 and State Issued Photo ID

Drop files here or

Max. file size: 50 MB.

Please make a copy of your DD–214 and blank out your SS# on it, then upload this copy to us.

How can we help you?

Your Comments/Questions(Required)

ARE YOU A VETERAN?

Bravo Foxtrot United Veterans Inc. offers aid to traumatized veterans that have been forgotten by the system, and by society.



631-224-4663



[email protected]



1A Railroad Plaza
Bay Shore, NY 11706

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Monday: Closed

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