(334) 271-7700 1400 Coliseum Blvd. Montgomery, AL 36110
mailing address: Post Office Box 301463, Montgomery, AL 36130-1463
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General Invoice Information
*Choose the type of payment you are making:
Description of Other Fees: required if "other" is chosen from list
*Additional Information/Fee Description:
Number on your ADEM invoice if provided:
Date on your ADEM invoice if provided: (ex: mm/dd/yyyy)
*Enter payment amount: (ex: xxx,xxx.xx)
Contact Information
*Company/Facility or Individual Name:
Facility Permit Number (if applicable):
Company or Facility Phone: (ex: xxx-xxx-xxxx)
*Contact Person:
*Contact Phone: (ex: xxx-xxx-xxxx)
Contact email address: (ex:
Name of an ADEM Program Staff Member (if known):
*Payment method:
Version 2.1.4