Type of Business *

Convenience Store

Food Truck

Gas Station

Grocery Store

Halal Meat Market

Restaurant

Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone Number *

(###)

###

####

Owner Name *

First Name

Last Name

Contact Name *

First Name

Last Name

Contact Cell Number *

(###)

###

####

Conditions of Sale *

Payment by ACH is required. This is an electronic transaction, adequate funds must be available for withdrawal from the account listed above. There will be a fee for insufficient funds. A minimum purchase of $500 is required for delivery (unless otherwise specified). Please contact A&A Halal via phone or email to communicate any and all account information changes.

I agree to all terms and conditions listed above