Prescription Discount Card Request

from Southern Insurance Associates

To request a free prescription discount card, enter your information below and we’ll mail you one!

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Prescription discount card request
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Note: leave the Subject field blank if you are a real person. If this field is filled in, your request will be ignored. This helps us protect against automated form posts (spam).

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706-996-8788
9:00 AM - 5:00 PM M-F
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If you need help with this form, or if you'd prefer to get a quote by phone or email, please let us know.

Southern Insurance Associates
408 N. Main Street
La Fayette, GA 30728

706-996-8788
9AM - 5PM Mon - Fri