CERTIFICATE AUTHORIZING THE

SALE OF CHOMETZ

I Hereby authorize Rabbi Tzvi Dechter to dispose of all Chometz that may be in my (our) possession wherever it may be – at home, at my (our) place of business, or elsewhere – in accordance with the requirements
of Jewish law as incorporated in the special contract for the sale of Chometz.

Contact Information:
Name:
Email Address:

Home Address:
Address:
City, State, Zip:

Office Address:
Address:
City, State, Zip:

DONATIONS ARE OPTIONAL -
ALTHOUGH IT IS CUSTOMARY TO DONATE AT LEAST A SMALL AMOUNT FOR THE CHOMETZ SALE PROCESS
Yes, I would like to donate: $

CC Number:
Exp
CVV
Billing Zip:

By submitting form I authorize Rabbi Tzvi Dechter to Sell my Chometz.
Initial Here: