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Business areas within State Farm determine who needs to have access to the secure content on B2B and initiate the registration process.

If you feel your business needs access to the B2B site, please submit this form and it will be routed to the correct business area.

We will get back to you as soon as possible.

Fields marked with * are required.

Registration is NOT required to submit a supplement request. Submit a supplement Here

What type of health care services do you provide? *
What type of repair services do you provide? *

Registration is NOT required to submit a supplement request. Submit a supplement Here

Registration is NOT required to submit a supplement request. Submit a supplement Here

(Characters remaining: 100)

Account administrators can find instructions on how to add or replace users here.
If you don't have a current administrator, please select "B2B Registration" for Reason for Contact.

Information for the primary contact person at your facility:

Please provide the primary email for your business and a direct phone number for use during registration.

(Multiple TINs or NPIs require multiple form submissions to enable multiple enrollment access.)

Company Details:
Are you currently doing business with State Farm?

This information will be stored in your company's profile in the State Farm directory. Please provide as complete information as possible.

Location Details:

Business Address:

Is billing address different than business address?
Comments/Questions:

(Characters remaining: 750)

By choosing to send a message to State Farm, you acknowledge that all information contained in your message, including questions, comments, suggestions, etc., shall not be deemed confidential, and State Farm shall have no obligation of any kind whatsoever with respect to such information, and shall be free to use, reproduce, disclose, and distribute the information to others without limitation.

Please refrain from entering Sensitive Personal information (SPI) in the comments field or formatting numbers that may resemble numbers like the following : Social Security Number, Number, Driver’s License Number , Financial Account Number(s) , Protected Health Information and Any Medical Information.

We value your privacy. We may collect personal information from you for business, marketing, and commercial purposes. Read more

Do Not Sell or Share My Personal Information (CA residents only)
WA My Health Notice (consumer/customer)
WA My Health Notice (B2B/Agent/job applicant)