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Section 1 of 8
Wholesale Application
After you fill out this order request, we will contact you to go over details and availability before the order is completed. If you would like faster service and direct information on current stock and pricing please contact us at (952) 592-6926 or mohammed@zamzamvitamins.com. Tier 1 prices on individual bottles are available at our brick and morter Lilburn Community Pharmacy only.
SHIPPING FEES ARE SEPERATE FROM TOTAL ORDER. IF YOU WOULD LIKE TO ARRANGE SHIPPING PLEASE CONTACT US. ALL WHOLESALE ORDERS MAY REQUIRE UP TO 3 WEEKS OF PROCESS TIME. PAYMENT IS DUE AT THE TIME OF PURCHASE.
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Zam Zam Vitamins Welcomes You To Our Team!
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Madinah Food Pantry INC
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211 Culver St South Lawrenceville Georgia 30043
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AUTHORIZATION AGREEMENT DIRECT PAYMENTS (ACH DEBITS)
I (We) hereby authorize Zam Zam Halal Vitamins LLC., through it’s Managing Agent (Chase Bank), to
initiate debit entries to my (our) checking/saving account indicated below and the bank named below, to
debit the same to such account. Your account will be debited at the time of order.

This authority is to remain in full force and effect until the Association has received written notification
from me (or either of us) of its termination in such manner as to afford Zam Zam Halal Vitamins LLC and Chase Bank a reasonable opportunity to act on it. .

ALL APPLICANTS MUST PROVIDE A COPY OF THEIR DRIVER’S LICENSE AND A VOIDED
CHECK OR DEPOSIT SLIP WITH THIS APPLICATION. Please email our accounts department at mohammed@zamzamvitamins.com
If the ACH Debit is declined due to Insufficient Funds or other
similar circumstances our return check fee of $30.00 will apply.
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Bank Name
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Routing Number
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Account Number
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Please Print Your Name and Sign Below [Must be the same name as the primary account holder]
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Section 2 of 8
Which Tier Is Right For Your Establishment?
Here at Zam Zam Vitamins we pride ourselves in making sure all of our wholesalers get the best return on investment. To decide on which profit margin fits best for your scale of business, please consider the following.
Wholesale prices are subjected to your tier; what tier do you fit? (We will review your order to ensure you get the maximum margins for profit)
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Tier 1 [10 bottles] (Minimum 5 quantity, Minimum 2 products)
Tier 2 [30 bottles] (Minimum 10 quantity, Minimum 3 products)
Tier 3 [120 bottles] (Minimum 30 quantity, Minimum 4 products)
Tier 4 [160 bottles] (Minimum 20 Bottles of 8 products)
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Section 3 of 8
Tier 1 (10% Profit Margin)
HSK: Hair Skin & Nails    |  D3= Vitamin D3 5000    |  MAN= Mountain Man    |  CG=Children's Gummies
B12= Vitamin B12           | FOG= Fish Oil Gummies |  AM= Adult MultiVits      |  EG= Elderberry Gummies  
Tier 1: Product Selection
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Section 4 of 8
Tier 2 (15% Profit Margin)
HSK: Hair Skin & Nails    |  D3= Vitamin D3 5000    |  MAN= Mountain Man    |  CG=Children's Gummies
B12= Vitamin B12           | FOG= Fish Oil Gummies |  AM= Adult MultiVits      |  EG= Elderberry Gummies  
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Section 5 of 8
Tier 3 (30% Profit Margin)
HSK: Hair Skin & Nails    |  D3= Vitamin D3 5000    |  MAN= Mountain Man    |  CG=Children's Gummies
B12= Vitamin B12           | FOG= Fish Oil Gummies |  AM= Adult MultiVits      |  EG= Elderberry Gummies  
Tier 3: Product Selection
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Section 6 of 8
Tier 4 (40% Profit Margin)
HSK: Hair Skin & Nails    |  D3= Vitamin D3 5000    |  MAN= Mountain Man    |  CG=Children's Gummies
B12= Vitamin B12           | FOG= Fish Oil Gummies |  AM= Adult MultiVits      |  EG= Elderberry Gummies  
Tier 4: Product Selection
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Section 7 of 8
Submit Payment
Payment is due at the time of purchase. Please enter your payment details.
Payment (Credit Cards/Debit Card/ACH Account) [Enter Name, EXP(MO/YEAR),CVV,ZIP CODE], [Routing#,Account#,Bank Name]
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Do you want us to save your card for future transactions?  
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Yes
No
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Section 8 of 8
Thank You
Zam Zam Vitamins wants to say... Jazakh'Allah Khair for you. Alhumdolilah for your support. Allahoakbar for the Ummah. and SubhanAllah for the mercy of Allah. If we have made any mistakes please take the time now to forgive us, If you are happy with our products please take the time now to say MashaAllah. We will continue to provide top quality Muslim products for you and your loved ones to enjoy.
Asalamualaikum.
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Madinah Food Pantry INC
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211 Culver St South Lawrenceville Georgia 30043
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AUTHORIZATION AGREEMENT DIRECT PAYMENTS (ACH DEBITS)
Bank Name
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Branch
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Bank Address
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Routing Number
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Account Number
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Please Print Your Name and Sign Below [Must be the same name as the primary account holder]
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Which Tier Is Right For Your Establishment?
Wholesale prices are subjected to your tier; what tier do you fit? (We will review your order to ensure you get the maximum margins for profit)
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Tier 1 (10% Profit Margin)
Tier 1: Product Selection
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Tier 2 (15% Profit Margin)
Tier 2: Product Selection
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Tier 3 (30% Profit Margin)
Tier 3: Product Selection
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Tier 4 (40% Profit Margin)
Tier 4: Product Selection
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Submit Payment
Payment (Credit Cards/Debit Card/ACH Account) [Enter Name, EXP(MO/YEAR),CVV,ZIP CODE], [Routing#,Account#,Bank Name]
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Do you want us to save your card for future transactions?  
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Thank You
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