Loestrin FE coupon (birth control pill)

[jemsam]

Hey there! If you fill out your information, you can print out a coupon for up to $35 off your out-of-pocket expense for Loestrin 24 FE. You bring it with you to the pharmacy when you p/u your prescription. It has a list of participating pharmacies on the print-out.

[joyfits378]

how do i get the coupon? how do i fill out my information that it says i need in order to get the coupon?