Certificate Authorizing The Sale Of Chometz

I (We, Husband and Wife, specify names)
hereby authorize Rabbi Yosef Levin 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.

Residence Address  Apt. No. 

City/State/Zip

Business Address Suite No.

City/State/Zip

Signature(s):  Date 

I understand that by clicking "submit" on this form it is a legal & fully binding substitute for my signature and I am authorizing Rabbi Yosef Levin to sell my Chometz.

Optional Donation: 

Your donation to Chabad is appreciated but not required for the authorization of Sale of Chometz to be completed. Thank you.

Full Name on Credit Card
Credit Card Number
Credit Card Expiration Date
Credir Card Security Code
Street Address
City
Zip Code
Email Address
Phone Number
Donation Amount