— Seeking Potential Victims in Law Firm Investigation

Contact Information

First Name

Middle Name

Last Name

Best Contact Number

Email Address

Address Line 1

Address Line 2

City

State

Country, if not USA

ZIP/Postal Code

Questions

1. What services did you hire Synergy Law to provide to you? (Select all that apply)

Loan modification

Loan refinance

Bankruptcy filing assistance

Other

1a. If other, please specify.

2. Please provide the property address subject to the loan modification, refinance, bankruptcy, etc.

3. Was Synergy Law able to obtain a loan modification on your behalf?

Yes
No
Not applicable

4. Was Synergy Law able to obtain a loan refinance on your behalf?

Yes
No
Not applicable

5. If you filed bankruptcy, who filled out your bankruptcy paperwork? (Select all that apply)

Synergy Law representative

Myself

Other

Not applicable

5a. If other, please specify.

6. If you filed bankruptcy, who filed your bankruptcy paperwork at the courthouse? (Select all that apply)

Synergy Law representative

Myself

Other

Not applicable

6a. If other, please specify.

7. If you filed bankruptcy, did a Synergy Law representative attend your bankruptcy hearings?

Yes
No
Not applicable

8. If you filed bankruptcy, did you complete the entire bankruptcy process and declare bankruptcy?

Yes
No
Not applicable

9. How much did you pay Synergy Law?

10. Who did you speak to at Synergy Law? (Provide names of attorneys and/or staff.)

11. Which (if any) Synergy Law office location(s) did you physically visit? (Select all that apply.)

Manassas, Virginia

Washington, D.C.

Not applicable

12. If you met any Synergy Law employees in person, please provide their names.

13. Did you send or receive any letters or packages via mail to or from Synergy Law?

Yes
No

13a. If yes, do you have any evidence of the mailings? (e.g. envelopes, tracking numbers, confirmation receipts, etc.)

Yes
No

13b. If yes, what Synergy Law address was the mailing sent to or received from?

14. Were you ever referred to—or was your case transferred to—Themis Law?

Yes
No

14a. If yes, did Themis Law resolve your case in a satisfactory manner?

Yes
No

14b. Please explain.

15. Have you reported Synergy Law to any regulatory or law enforcement agency? (e.g., Better Business Bureau, Federal Trade Commission, local/state/federal law enforcement, etc.)

Yes
No

15a. If yes, when did you report, and to which agency?

Privacy Act Statement

The FBI is authorized to collect the information on this form by one or more of the following provisions: Title 28, United States Code, sections 533 and 534; Title 28, Code of Federal Regulations, section 0.85; and the Attorney General Guidelines for Victim and Witness Assistance. The information requested will assist the FBI in providing you with assistance to which crime victims are entitled under federal law. You do not have to provide the requested information; however, failure to do so may hinder the FBI in providing you with crime victim assistance. The information collected on this form is protected by the Privacy Act of 1974, as amended, Title 5, United States Code section 552a, and is maintained in the FBI’s Central Records System, DOJ/FBI-002, a description of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) and which may be viewed at www.justice.gov/opcl/doj-systems-records#doj

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Seeking Potential Victims in Law Firm Investigation