ALTERNATIVE DISPUTE RESOLUTION (‘ADR’) FORM

The form below must be completed in its entirety and submitted electronically or by post. Please note that we will not respond to ADR requests made for sites that are not registered with the eCOGRA ADR Service.

Personal Details Title
Full Name
City
Country
Contact Number
Email

Site Details Site
URL
i.e.: www.ecogra.org
Your Username
Date of Incident
Contact Email

Software Provider Information Did you inform software provider of dispute
If so, to whom

Your Dispute

Security

Security code

By submitting this dispute I verify the information provided is accurate and true and consent to eCOGRA having access to my personal information held by the approved licence holder. I have read and agree to abide by the Policies and Procedures. I understand an accredited ADR mediator will contact me within five business days and may, at that time, request copies of any e-mails or other relevant documentation.