THE LAW OFFICE OF DAVID PEARLINE THE WHISTLEBLOWER'S ATTORNEY
THE CONTACT QUESTIONNAIRE Name Address Please enter full address here. Telephone E-Mail Address Provide Details of False Claim: Provide as much detail about fraud here. Include name of person, partnership or corporation that is defrauding the government. Date Fraud Began: Is Fraud Continuing: Yes No Describe Evidence of Fraud. Describe evidence of fraud, including the existence of any documents, whether your knowledge of fraud is first hand, the names of any witnesses and whether they would be willing to testify. Estimate of Money Lost by Government as a result of fraud What is your position with company that committed fraud? Describe here your position with company. Who Have You Told About Fraud? Specify who you have told about fraud here. State whether the government is aware of the fraud. Has the Fraud Been Reported to the Public? Describe here whether fraud was reported in the media. Has the Government taken any action regarding the fraud? State whether the government has filed charges against the company or began an investigation. Are You Willing to Make Your Charges Public by filing a lawsuit? Yes No Is there Any Other Relevant Information? Specify here any other relevant information that was not listed above. I understand that by submitting this information, I am not forming an attorney-client relationship with Mr. Pearline, and that such a relationship can only be formed by both myself and Mr. Pearline executing a representation agreement. Please check here to acknowledge that you understand this statement.
THE CONTACT QUESTIONNAIRE
What is your position with company that committed fraud?
DAVID PEARLINE 1064 Laskin Road, Suite 22 C Virginia Beach, Virginia 23451 Tel: (757)-428-8828 Fax: (757)-428-8828 E-Mail: David Pearline
