New Jersey Business Closing/Mass Layoff Notification Form

The Great Seal of the State of New Jersey
Company Information

Please Enter All Applicable Information

**
Enter Company Name
Company Federal Identification Number
North American Industrial Classification System Code
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
Company Address
**
(First, Middle, Last)
Name of the person to contact
**
Company Telephone Number
(333)333-3333
Company Fax
(333)333-3333
**
Company Email Address
yourname@abc.com

(** indicates a required field)

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