Form Nj-1065 - New Jersey Division Of Revenue E-File Registration Form For Software Developers And/or Transmitters - 2002

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Rev 1/1/02
NJ-1065
New Jersey Division of Revenue E-file
REGISTRATION FORM
For SOFTWARE DEVELOPERS +/or TRANSMITTERS
Software developers and transmitters must register to participate in the e-filed NJ-1065, New Jersey
Partnership Return, program. If you have any questions regarding completing this form, please call
609.633.1132.
Please type or print
COMPANY NAME -
_____________________________________________
COMPANY ETIN -
_____________
COMPANY FID/FEIN -
___________________
TRADE NAME (if any) -
___________________________________________
ADDRESS -
______________________________________________
CITY, STATE, ZIP
______________________________________________
CONTACT PERSON
_______________________________________________
E-MAIL
________________________________________________
TELEPHONE
____________________
EXTENSION __________
FAX
____________________
E-mail the completed form to -
TBACHMAN@REVENUE.STATE.NJ.US
Or Fax the form to -
(609) 292-1777
Or mail the form to –
NEW JERSEY DIVISION OF REVENUE
E-FILE NJ-1065
P O BOX 191
TRENTON NJ 08646-0191
1

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