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 # *

Invoice #

Email Address *

example@example.com

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.

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

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

Security Statement

Pay your bill at ADRSystems.com with confidence. We have partnered with Authorize.Net, a leading payment gateway since 1996, to accept credit card payments safely and securely.

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128-bit Secure Sockets Layer (SSL) technology for secure Internet Protocol (IP) transactions
Industry leading encryption hardware and software methods and security protocols to protect customer information
Compliance with the Payment Card Industry Data Security Standard (PCI DSS)
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