Chametz Rabbi Grossman - The Bais HaVaad Halacha Center

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First Name*
Last Name*
Best Phone*
Email*
Address
Street Address Address Line 2 City State ZIP Code
Address of Premises That Contain Chametz
Street Address Address Line 2
Location 1
Location 2
Additional Addresses and Locations of Chametz
Please check which chametz items will be included in this sale:
- Liquor
- Groceries
- Perfumes
- Cosmetics
- Medications
- Stocks in chametz Companies
- Other
Location of Keys or number you can be reached at:
An Underestimated Approximate Value of Chametz:
City that I will be in at the start of Pesach:
City that I will be in at the close of Pesach:
Other Comments:
Please read the following and press Next on the form below to appoint Harav Dovid Grossman to act as your agent for the selling of your Chametz.*
By checking this box and clicking "Next" below as well as “Submit” on the following page I hereby appoint Rav Dovid Grossman of The Bais HaVaad Halacha Center to act as my official Halachic agent to take all Halachic and legal actions necessary to effectuate the selling of my chametz. His hand shall be my hand, his voice shall be my voice, his actions shall be my actions.
Please read the following and submit the form below to appoint Harav Dovid Grossman to act as your agent for the selling of your Chametz.

I the undersigned, instruct and empower Harav Dovid Grossman of The Bais HaVaad Halacha Center, to act as my agent to sell all the chametz that I possess. Said chametz shall include any and all chametz as defined by the Torah and Rabbinic Law e.g. classic chametz, questionable chametz, all kinds of chametz mixtures, chametz that tends to affix itself to surfaces of pans, pots, or cooking utensils, as well as pet food that contain chametz or chametz mixtures. This shall include all chametz that I am aware of as well as chametz that I am not aware of. (herein “chametz”)
In addition, I hereby instruct and empower Harav Dovid Grossman, to lease all places wherein any forms of chametz may be found, particularly at the address/es listed herein, and elsewhere anywhere in the world.

In addition, I hereby give Harav Dovid Grossman the full right and power to appoint any agent, substitute, or designee in his stead (herein the "Attending Rabbi"). Said Attending Rabbi shall have full right to sell and lease as provided herein. In addition, I hereby appoint and empower the abovementioned Attending Rabbi as my direct agent to act on my behalf as specified herein. The Attending Rabbi has the full power and right to act as he deems fit and proper in accordance with all the details of the Bill of Sale used in the transaction to sell all my chametz, as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws.
Wherever possible it is ideal to effectuate the above process using a valid Kinyan. Please call the Bais HaVaad office to finalize the process. Bais Havaad will attempt to contact you at the above phone number as well. Should a personal connection not be made, this form will suffice to effectuate the process. Bais HaVaad wishes you a Chag Kasher V'Sameach!!

Mechiras Chametz Acknowledgement for Rabbi Grossman:
Maos Chittim Donation:
Please distribute:
Enter Maos Chittim Amount (per needy family)*
Please distribute the above Maos Chittim amount to the following number of needy families
Maos Chittim Amount
Please distribute the above total Maos Chittim amount on behalf of myself as well as on behalf of
Additional members of my family
Maos Chitim Subtotal
Price: $0.00
Maos Chitim Subtotal
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Formula
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Formula Amount
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Total donation to be processed:
$0.00
Please distribute to families in:
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Total donation to be processed:
$0.00
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