NJ Division of         Revenue and Enterprise Services 
 
           Request for Authorization  to Report Form WR-30  Electronically 
 
   SECTION  I•   Employer 
   TPID  (EIN + 000)   
   Company   Name      
   Address             

   State and Zip       
 
   SECTION   II.-    Submitter (If Other Than Above) 
   TPID  (EIN + 000)   
   Company Name        
   Address             

   State and Zip       
 
   SECTION   Ill.-   Contact Person 
   Name               
   Title              
   Address            

   State and Zip      
   E-Mail             
   Telephone          
   FAX                
 
         Please email back to: joellen.stevens@treas.nj.gov 
                                     
         Questions?  Call (609) 609-292-8653 
 
         Or visit our web site at www.state.nj.us/treasury/revenue