1Schedule2Details3Payment TokenPlease choose the type of case and the time and date for your mediationCase Type*Please Choose your Type of CasePersonal InjuryWorkers CompContractOther (Non-domestic)Time*Please Select a Time for your MediationMorning (9am-12pm)Afternoon (1pm-4pm)Time*Please Select a Time for your MediationMorning (9am - 2pm)HiddenDemand Offer*Demands100K or LessDate* MM slash DD slash YYYY Please provide the case and party detailsCase Style* Please do not use : / ? # [ ] @ ! $ & ' ( ) * + , ; = as characters in your case style.County* State*StateGeorgiaFloridaNorth CarolinaCase Number Court Is this a court-ordered mediation?* Yes No Who do you represent?Select a side* Represents the Plaintiff Represents the Defense Scheduling AttorneyScheduling Attorney* Firm Name Representing* Insurance Carrier* Email* Enter Email Confirm Email Additional CC Enter Email Confirm Email Scheduling Attorney's Phone*Opposing CounselDefense Attorney* HiddenRepresenting* Represents the Plaintiff Represents the Defense Insurance Carrier Plaintiff's Attorney* HiddenRepresenting* Represents the Plaintiff Represents the Defense Representing* Email* Enter Email Confirm Email Additional CC Enter Email Confirm Email Opposition Attorney's Phone Please provide payment information.Payment Method*Credit CardInvoicePayment Method*Credit CardCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agreements* By attending mediation, I agree to ADR On-Demand's Agreement to Mediate Online. Agreements* This fee is non-refundable if canceled within 48 hours of the scheduled mediation. Agreements* I understand the mediation will not exceed 3 hours. Agreements* I acknowledge that this mediation will be cancelled if payment is not received at least 48 hours before the scheduled mediation (notification will be sent only in the event of cancellation) Promo Code Companion Case Information Virtual Mediation* Price: Virtual Mediation* Price: Book One Get One PromoADRVIPLOYALTY (20% OFF)* Price: You earned $150 savings toward your Mediation > Thank you being a loyal client of ADR On-Demand!Fain* Price: Companion Case Price: Companion CaseADR Loyalty Promo (25% OFF)* Price: Thank you for being an awesome client. Virtual Mediation* Price: Multi-party Companion CaseVirtual Mediation* Price: TotalHiddenmnum HiddenStatus Total $0.00 CommentsThis field is for validation purposes and should be left unchanged. ADR On-Demand relies on email confirmation to book online mediations. Please notify the other party in your case that you are scheduling a mediation and to expect an email from support@adrondemand.com