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
(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
Company Fax
Company Email Address

(** indicates a required field)

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