Please read the following and submit the form below to appoint Dayan Dovid Grossman to act as your agent for the selling of your Hametz.

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

In addition, I hereby give Dayan 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 Hametz, as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws.