By submitting this information, you authorize Rabbi Avraham Scheinberg of 14135 Sholom Place, City of San Antonio, and State of Texas, to sell, transfer, and assign on your behalf all CHAMETZ (except for that which you intend to use between the time of the sale and the time to destroy chametz on Shabbat morning) of whatever kind and nature of which you  possess , or in which you may have an interest, wheresoever situated in my residence at or in your place of business, or in any other place, without reservation or limitation. You authorize the agent to rent out and grant rights of access to any area in which your chametz is located, even if to get there the buyer has to go through other parts of your property. These rights are non-exclusive, so you can still use those areas.
You authorize the agent to sell chametz that you don't yet own, but will become yours before the time that you're not allowed to deal in chametz, or that will become chametz on Pesach. You declare that you reject ownership or possession of anything that might become chametz on Pesach, and that the non-Jewish buyer is free to acquire that chametz from hefker (its ownerless state).
You authorize the agent to write a document of sale to the buyer in any way he chooses. You authorize the agent to delegate his rights and responsibilities to others to effect the sale. Important: In the Notes please include your address or addresses, a more exact location of Chametz in your home, the estimated value and if you will be in a different time zone for Passover.