subject_line
Whistleblowers - Free Case Evaluation
Step 1: Tell Us About You
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number - Optional
Alternate Phone - Optional
Email Address
*
Step 2: Tell Us About the Company or Person Defrauding the Government
Name
Location
Are you a current or former employee of the company or person?
Current
Former
Never Employed There
What goods or services does this company or person provide the government?
What government agencies does this company or person deal with?
Step 3: Tell Us About the Fraud
What has the company or person done to defraud the government?
Which individuals were involved in the fraudulent conduct, and what did each of them do?
When did you learn of the fraud?
When did the fraudulent scheme start, and how long did it last?
Did you discuss your concerns with your employer or a supervisor?
Yes
No
Please provide details:
Did you discuss your concerns with anyone else?
Yes
No
Please provide details
:
Has the fraudulent conduct been reported in the media or investigated by the federal or state government?
Yes
No
Please provide details
:
Did you suffer any retaliation as a result of anything you did related to the fraudulent conduct?
Yes
No
Please provide details
:
What is your best guess as to the dollar cost to the government of the fraud, and how do you estimate it?
Please provide details
:
Do you have any other evidence of the fraud (e.g., documents, emails, recordings)?
Yes
No
Please provide details
:
Have you ever filed a lawsuit against any person, company, or the government, and if so, what was the case about?
Yes
No
Please provide details
:
Is there anything else you want us to consider in evaluating your case?
Yes
No
Please provide details
:
Step 4: Submit Your Case for Evaluation
To have The Vernia Law Firm evaluate the case you have described above, please enter your name and today's date to acknowledge that you have read the conditions and agree to them.
First Name
Last Name
Date
+
Powered by
Report abuse