David Pearline
1064 Laskin Road, Suite 22C
Virginia Beach, Virginia 23451
davidpearline@msn.com
(757)-428-8828

 

THE CONTACT QUESTIONNAIRE

Name  
Address

Telephone 

E-Mail Address

Provide Details of False Claim:

Date Fraud Began:

Is Fraud Continuing:

Yes  No

Describe Evidence of Fraud.

Estimate of Money Lost by Government as a result of fraud

What is your position with company that committed fraud?

Who Have You Told About Fraud?

Has the Fraud Been Reported to the Public?

Has the Government taken any action regarding the fraud?

Are You Willing to Make Your Charges Public by filing a lawsuit?

Yes  No

Is there Any Other Relevant Information?

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.