Chometz Sale Form
Submit this form, or send it to us by email or mail, and we will take care of having your Chametz sold for you. You can also fax it to us at 213-232-3284

Make sure we receive this form by Sunday night, April 17

I, (we*) hereby authorize Rabbi Dov Wagner to dispose of all Chometz 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. #
City/State/Zip

Business Address
City/State/Zip

Signature(s)

Date

Email

Phone

*husband and wife, specify names.