Qui Tam Information

1-866-242-0905

Qui Tam Litigation Free Case Review

Begin your FREE Review Today.
Fill out the form below or call us toll free at
1-866-242-0905

This free case review form is very long and detailed. Do not feel it is required to fill out all fields and provide answers to every question. Do the best that you can. The more information we receive, the easier it is for our qualified attorneys to determine whether or not you may have a viable case.

Contact Information

First Name
Last Name
Home Phone - -
Work Phone - -
Cell Phone - -
Email
Confirm Email
Street Address
City
State
Zip

Case Information

Profession
Name of Employer
Companies suspected to be involved
Company State
What actions/activity was fraudulent?
Who was involved in the fraud?
What are the individuals positions and what "role" did they play in the fraud?
Start date
Has the fraud ended?Yes No
Stop Date
Were you involved in the fraud?Yes No
If yes, please describe:
What documents do you have that can prove this fraud occurred?
Who will support your supposed fraud claim?
What evidence/documentation can they provide?
Have you talked with ANYONE about this fraud (this applies to loved ones, coworkers, employers, media, government officials, etc..)Yes No
If yes, please describe who you talked with and the details and outcome of the discussion.
If you talked with your employer about this supposed fraud, did your employer change any policies or attempt to retaliate against you?Yes No
If you lost your job, have you filed a lawsuit against your employer for wrongful termination?Yes No
Do you currently have a law firm or attorney representing you with this lawsuit?Yes No
How much money is potentially involved in this wrongdoing or fraud?
Do you believe that any people have been harmed as a result of this fraud?Yes No
Questions, comments, additional information

Digital Signature

If you would like our law firms to review your potential case please enter your name and date in the fields below and review the checked boxes and click "Submit". This form cannot be submitted with out your digital signature and date.

Name
Date

Disclaimers

I agree that submitting this form and the information contained within does not establish an attorney client relationship.
I agree that my information will be reviewed by more than one attorney and/or law firm.
I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.