Forensic Hotline Form - Eide Bailly LLP

We, the undersigned, agree to use the Fraud Hotline and have it available to all employees. Any information called into the hotline will be made available to us in memorandum form within two working days of the information being received by Eide Bailly LLP. We understand the hotline is a relay of information and Eide Bailly LLP makes no assumption or conclusion as to the truthfulness of the information received. Any follow-up requested of Eide Bailly LLP would require a separate engagement letter. We understand we will be charged a one-time set up fee of $100 for materials (5-10 posters and up to 300 paycheck stuffers) to market the hotline to staff.

We agree to perform the following functions related to our services in connection with this engagement:

Make all management decisions and perform all management functions.
Designate a competent individual to oversee the services.
Evaluate the adequacy and results of the services performed.
Accept responsibility for the results of the services.
Establish and maintain internal controls, including monitoring ongoing activities.

The following individuals will be our contacts for reported information:

Name:

Position:

Phone:

Fax:

E-mail:

Contact 2 (Optional):

Name:

Position:

Phone:

Fax:

E-mail:

A written memorandum summarizing the information received will be sent to one of the above designated contacts. The hotline service is billed at $75 per call. Billing will be sent after the designated contact has been notified.

Check this box, if you accept this agreement.
(Authorizing Official Signature)	Date Signed

Billing Address:

Company:

Address 1:

Address 2:

City:

State:

Zip:

*Click Submit to email your request.

An Email will be produced for your records and emailed to the email address of the first contact.