Register as a Professional Employer Organization (PEO)

This form is for Professional Employer Organizations (PEOs) with Workers’ Compensation policies only. Visit these links to register as a policyholder or broker.

An NJM representative will process your registration and you will receive an email to activate your account.

Please provide the following information:

*Required Fields

Please review the form for errors highlighted in red.

First Name

Last Name

Phone Number

e.g., 123-456-7890

Extension

Email Address

PEO Name

Federal Employer Identification Number (FEIN)

e.g., 12-1234567