ADR Systems Credit Card Form

To pay your bill with ADR Systems using a credit card, please complete the form below. For questions, please contact us at 312.960.2260 or at payments@adrsystems.com.

ADR Systems File # or Invoice #*

Email Address*

Attorney Name

Firm Name

Payment Amount*

A 3% credit card processing fee will be added

Total Amount with Processing Fee

Total Amount*

USD

Credit Card Information

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Terms & Conditions

The following are additional “Terms & Conditions” pertaining to dispute resolution services provided by ADR Systems of America, LLC (“ADR Systems”). These Terms & Conditions shall apply to each Party (“Party”) to a signed Agreement (“Agreement”) for dispute resolution services provided by ADR Systems.

1.1 Fees. Parties shall pay all fees specified in your Agreement with ADR Systems.

1.2 Payment. Parties shall pay fees by one of four methods: (1) Mail a check payable to ADR Systems, 20 North Clark Street, Floor 29, Chicago IL 60602; (2) VISA, Mastercard, Discover and American Express credit cards are accepted with a 3.0% processing fee; (3) Zelle using email address adrsystems20@gmail.com (4) Wire transfer by contacting ADR Systems at payments@adrsystems.com

1.3 Overdue Payments, Refund Information, Payment Disputes. See your Agreement.

1.4 By submitting this form, I agree to the terms and conditions.

Please verify that you are human*

Security Statement

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