Community Lifelines & Assistance
Ph: (480) 206-6590
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America's Free Prescription Discount Cards
Print a Free Discount Card
Card Partners
Download the ADC a.k.a. CAP Power Point Presentation
Order ADC Discount Cards Form
Diabetic Supplies
Pet Discount Drug Card
Rx Med Assist
Contact Us
Referrals
You may order a supply of cards using this form
to give to your patients, members or customers.
If you need a card or a few cards for personal or
family use, you may print one from the America's
Drug Card site by
clicking here
.
Name
*
First
Last
Name of clinic, business, or group
*
If you are a clinic, business or group, please type your name.
Email
*
Phone number and best time to call
*
Mailing street address or P.O. Box
*
City, State, Zip code
*
Number of cards to ship -- please consider a 3 months supply
*
100 free cards
200 free cards
500 free cards
1000 free cards
Comment(s), questions or other helpful info
*
Submit