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 UPTO 3 WEEKS OF PROCESS TIME. PAYMENT IS DUE AT THE TIME OF PURCHASE.
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Business Name *
Billing Address *
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.
Bank Name *
Branch
Bank Address *
Routing Number *
Account Number *
Please Print Your Name and Sign Below [Must be the same name as the primary account holder] *
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