1Schedule2Details3Payment TokenSchedule a Virtual MediationChoose a Mediation Date* MM slash DD slash YYYY Choose a Start Time*Morning ( 8:00am EST)Morning ( 9:00am EST)Morning ( 10:00am EST)Morning ( 11:00am EST)Afternoon ( 12:00pm EST)Afternoon ( 1:00pm EST)Afternoon ( 2:00pm EST)Case Style* Please do not use : / ? # [ ] @ ! $ & ' ( ) * + , ; = as characters in your case style.Case Type*Please Choose your Type of CasePersonal InjuryWorkers CompContractOther (Non-domestic)HiddenState*StateGeorgiaFloridaNorth CarolinaTennesseeUntitled*StateGeorgiaFloridaNorth CarolinaTennesseeCounty* Case Number Court Is this a court-ordered mediation?* Yes No HiddenHow many parties are involved in the disputes to be resolved at this mediation?*Number of Case Parties2 parties3 parties4+ parties 2 Parties Example: One Plaintiff, one Liability Carrier is two (2) parties. 3 Parties Example: One Plaintiff, one Liability Carrier and one UM Carrier is three (3) parties. 4+ Parties Example: 1 Plaintiff and 3 Defendants is four (4) parties.HiddenHow much time will you need?*3 Hours5 HoursHiddenHow much time will you need?5 HoursPlease Note: To ensure quality of mediation, cases with 4 or more participating parties require 5 hours.HiddenTime*Please Select a Time for your MediationMorning (9am - 2pm)HiddenDemand Offer*Demands100K or LessHiddenDo you have a preferred mediator?Wayne C. WilsonJohn AustinAudrey BerlandMichael EshmanRusty GrantBianca Motley BroomJason HarperKristen PittsKay ThompsonTabitha PonderLeesa BohlerShuli GreenJim SheaElizabeth ToddCade ParianBryan SutliveLarry MimsMichael HolmesHidden* I understand this is only a request; if my preferred mediator is unavailable, the mediation will be randomly assigned to another ADR On-Demand mediator. Party Details Who do you represent?Select a side* Represents the Plaintiff Represents the Defense Scheduling AttorneyScheduling Attorney* Firm Name Representing* Insurance Carrier* Attorney's Email* Paralegal/Assistant 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* Attorney's Email* Paralegal/Assistant Email Opposition Attorney's Phone Add Third-Party Counsel Information Please include attorney name, email, and phone number for any additional billiable parties.Additional Party Info Please provide payment information.Payment Method*Credit CardInvoiceCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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* All mediation fees are due if canceled within 24 hours of the mediation, and a partial fee will be assessed if rescheduled within 24 hours. Agreements* I understand the mediation will not exceed 3 hours. HiddenAgreements* 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) HiddenPromo Code Companion Case Information 3-Hour Virtual Mediation Fee* Price: 3-Hour Virtual Mediation Fee* Price: 3-Hour Virtual Mediation Fee* Price: 5-Hour Virtual Mediation Fee* Price: TotalHiddenmnum HiddenStatus CAPTCHATotal $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