Online Fraud Hotline Engagement Form -- Eide Bailly LLP

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Forensic Services
Director:
Jeremy Bendewald
866.999.8362
E-mail Jeremy

Online Fraud Hotline Engagement Form

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.

The following individuals will be our contacts for reported information:
Contact 1 (Required)
Name:
Position:
Telephone:
Fax:
E-mail:

Contact 2 (Optional)
Name:
Position:
Telephone:
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 Name:
Address 1:
Address 2:
City:
State:
Zip:

*Click Submit to email your request.
A Word document will be produced for your records. Just open, print, and/or save.
If you do not have Microsoft Word click here for a Word Viewer.

Thank You!

Thank you for your submission.

SECURE SERVICES