Rev. 5/08 
 
 •                  NJ Division of         Revenue 
 
                    Authorization  to Report WR-30   Electronically Thru Axway 
 
            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