Online Application

Online Application Form

Once your application is submitted a trained and Certified Credit Counselor will contact you within 2 to 4 hours of its receipt depending upon the time of submission. If you prefer to contact us by phone, call toll free 800-498-0766 ext 190 or email us by clicking on the email icons. From this point on you will be assigned a counselor to assist you throughout the enrollment process. Your counselor will review your budget sheet, calculate a monthly payment, explain the new interest rates, and give you an approximate repayment term. Additionally, your counselor will explain the educational material and coursework available to your by ADR.
Our office will not continue our process until you are satisfied with your new payment arrangements. We will then ask you to review and complete all of your enrollment forms. At this time you should be considering a due date for your monthly payment. While you are waiting to be contacted by us, you should gather all your account(s) information. Keep in mind, you will not fully know the benefits of our program until you speak with us.

Your Name ( * )
Postal Code
Your Email ( * )
Home Phone ( * )
Work Phone
Best Time to call
Estimated amount of unsecured debt
Do you Own your home ?
My Accounts are
My Payments are
Reason for contacting ADR ?
How did you hear about ADR ?

The successful implementation and monthly maintenance of a debt management program is a shared responsibility. You want to ensure that the agency you share this responsibility with will support your program professionally and efficiently.