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	Sell Your Chametz - Jewish Russian Community Centre of Ontario
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window.formJson = Object.extend([{"form_height":450,"1_text":"\u003cp\u003eSince it is prohibited to possess chametz on Pesach, any chametz left undisposed must be sold to a non-Jew. [Any chametz remaining in the possession of a Jew during Pesach may not be used, eaten, bought or sold even after Pesach.]\u003c/p\u003e\n\n\u003cp align=\"justify\"\u003e\u003cimg align=\"left\" alt=\"\" src=\"http://chabad.ca/media/images/13549.jpg\" style=\"float:left\"\u003eTherefore, all chametz that will not be eaten or burned before Pesach and all chametz utensils that will not be thoroughly cleaned by then should be stored away.\u003c/p\u003e\n\n\u003cp align=\"justify\"\u003eThe storage area should be locked or taped shut to be leased to the non-Jew at the time of the chametz sale.\u003c/p\u003e\n\n\u003cp align=\"justify\"\u003eSince there are many legal intricacies in this sale, only a competent rabbi should be entrusted with its execution. The rabbi acts as our agent both to sell the chametz to the non-Jew on the morning before Pesach starts and also to buy it back the evening after Pesach ends.\u003c/p\u003e\n\n\u003cp align=\"justify\"\u003eThe following form should be filled out and given or emailed to Rabbi Yoseph Y. Zaltzman by 9 am, Tuesday, March\u0026#160;31, 2026. \u003ca href=\"https://www.jrcc.org/holidays/passover/pesach_cdo/aid/3640536/jewish/FAQ-About-the-Sale-of-Chametz.htm\"\u003eread more...\u003c/a\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cspan style=\"color:#2980b9;\"\u003eПоскольку владение хамецом во время Песаха запрещено, весь хамец, который не будет уничтожен к началу праздника, необходимо \u003cstrong\u003eпродать нееврею\u003c/strong\u003e.\u003cbr\u003e\n[Любой хамец, оставшийся у еврея во владении во время Песаха, \u003cstrong\u003eзапрещено употреблять в пищу, продавать или использовать даже после Песаха\u003c/strong\u003e.]\u003c/span\u003e\u003cbr\u003e\n\u003cspan style=\"color:#2980b9;\"\u003eПоэтому весь хамец, который не планируется съесть или сжечь до наступления Песаха, а также посуда, использовавшаяся для хамеца и не прошедшая тщательную очистку, должна быть \u003cstrong\u003eнадёжно упакована и убрана\u003c/strong\u003e.\u003c/span\u003e\u003cbr\u003e\n\u003cspan style=\"color:#2980b9;\"\u003eМесто хранения необходимо \u003cstrong\u003eопечатать или закрыть на замок\u003c/strong\u003e \u0026acirc;\u0026euro;\u0026quot; оно будет сдано в аренду нееврею на время праздника вместе с хамецом.\u003c/span\u003e\u003cbr\u003e\n\u003cspan style=\"color:#2980b9;\"\u003eПоскольку процедура продажи хамеца включает в себя множество тонкостей в соответствии с еврейским законом, её следует поручать только \u003cstrong\u003eкомпетентному раввину\u003c/strong\u003e. 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<form class="userform-form" action="" method="post" name="form_5483384" id="5483384" accept-charset="utf-8"><input type="hidden" name="formID" value="5483384" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div id="text_1" class="form-html"><p>Since it is prohibited to possess chametz on Pesach, any chametz left undisposed must be sold to a non-Jew. [Any chametz remaining in the possession of a Jew during Pesach may not be used, eaten, bought or sold even after Pesach.]</p>

<p align="justify"><img align="left" alt="" src="http://chabad.ca/media/images/13549.jpg" style="float:left" />Therefore, all chametz that will not be eaten or burned before Pesach and all chametz utensils that will not be thoroughly cleaned by then should be stored away.</p>

<p align="justify">The storage area should be locked or taped shut to be leased to the non-Jew at the time of the chametz sale.</p>

<p align="justify">Since there are many legal intricacies in this sale, only a competent rabbi should be entrusted with its execution. The rabbi acts as our agent both to sell the chametz to the non-Jew on the morning before Pesach starts and also to buy it back the evening after Pesach ends.</p>

<p align="justify">The following form should be filled out and given or emailed to Rabbi Yoseph Y. Zaltzman by 9 am, Tuesday, March 31, 2026. <a href="https://www.jrcc.org/holidays/passover/pesach_cdo/aid/3640536/jewish/FAQ-About-the-Sale-of-Chametz.htm">read more...</a></p>

<p><span style="color:#2980b9;">Поскольку владение хамецом во время Песаха запрещено, весь хамец, который не будет уничтожен к началу праздника, необходимо <strong>продать нееврею</strong>.<br />
[Любой хамец, оставшийся у еврея во владении во время Песаха, <strong>запрещено употреблять в пищу, продавать или использовать даже после Песаха</strong>.]</span><br />
<span style="color:#2980b9;">Поэтому весь хамец, который не планируется съесть или сжечь до наступления Песаха, а также посуда, использовавшаяся для хамеца и не прошедшая тщательную очистку, должна быть <strong>надёжно упакована и убрана</strong>.</span><br />
<span style="color:#2980b9;">Место хранения необходимо <strong>опечатать или закрыть на замок</strong> â€" оно будет сдано в аренду нееврею на время праздника вместе с хамецом.</span><br />
<span style="color:#2980b9;">Поскольку процедура продажи хамеца включает в себя множество тонкостей в соответствии с еврейским законом, её следует поручать только <strong>компетентному раввину</strong>. Раввин выступает в роли уполномоченного (шалиях) от нашего имени: он продаёт хамец нееврею утром перед началом Песаха и выкупает его обратно вечером после окончания праздника.</span><br />
<span style="color:#3498db;"><strong>Пожалуйста, заполните и передайте (или отправьте по электронной почте) прилагаемую форму раввину Йосефу Й. Зальцману не позднее 9:00 утра в Вторник, 31 марта 2026 года.</strong></span></p>
</div> </div></li><li class="form-line always-hidden" id="id_4"><div id="cid_4" class="form-input-wide"> <div id="text_4" class="form-html"><p>I, the undersigned, fully empower and permit Rabbi Yoseph Y. Zaltzman to act in my place and stead, and on my behalf to sell all Chametz possessed by me, knowingly or unknowingly as defined by Torah and Rabbinic law (e.g. Chametz, possible Chametz, and all kinds of Chametz mixtures). Also Chametz that tends to harden and adhere to the inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating Chametz and mixtures thereof. Rabbi Yoseph Y. Zaltzman is also empowered to lease all places wherein the Chametz owned by me may be found, particularly at the address/es listed below and elsewhere. Rabbi Yoseph Y. Zaltzman has full right to appoint any agent or substitute in his stead and said substitute shall have full right to sell and lease as provided herein. Rabbi Yoseph Y. Zaltzman also has 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 any Chametz, Chametz mixtures, etc., as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws.</p>
</div> </div></li><li class="form-line" id="id_18"><div id="cid_18" class="form-input-wide"> <div id="text_18" class="form-html"><p style="text-align: center;"><span style="color:#2980b9;"><span style="font-size:20px;"><strong> DELEGATION OF POWER TO SELL CHAMETZ / ДОВЕРЕННОСТЬ НА ПРОДАЖУ ХАМЕЦА</strong></span></span><br />
<em><span style="font-size:11px;">Please read the entire bill of sale before signing. Пожалуйста, внимательно ознакомьтесь с полным текстом договора купли-продажи перед подписанием.</span></em></p>

<p style="text-align:center"><img alt="" height="602" src="https://w2.chabad.org/media/images/1317/QlkV13175304.jpg" width="780" /></p>
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class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q6_fullName[first]" id="first_6" autocomplete="given-name" />  <label class="form-sub-label" for="first_6" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q6_fullName[last]" id="last_6" autocomplete="family-name" />  <label class="form-sub-label" for="last_6" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q9_phoneNumber[area]" id="input_9_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_9_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q9_phoneNumber[phone]" id="input_9_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_9_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_10" name="q10_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Address<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q8_address[addr_line1]" id="input_8_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_8_addr_line1" id="sublabel_8_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q8_address[addr_line2]" id="input_8_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_8_addr_line2" id="sublabel_8_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q8_address[city]" id="input_8_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_8_city" id="sublabel_8_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q8_address[state]" id="input_8_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_8_state" id="sublabel_8_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q8_address[postal]" id="input_8_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_8_postal" id="sublabel_8_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q8_address[country]" id="input_8_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_8_country" id="sublabel_8_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Additional address/es and locations of chometz </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <textarea id="input_7" class="form-textarea" name="q7_input7" cols="40" rows="6"></textarea> </div></li><li id="cid_14" class="form-input-wide"> <div class="form-header-group"><h3 id="header_14" class="form-header">Electronic Signature(s)</h3><div id="subHeader_14" class="form-subHeader">Type the names of all parties selling chometz</div></div> </li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Signature<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_15" name="q15_input15" size="20" value="" /> </div></li><li id="cid_16" class="form-input-wide"> <div class="form-header-group"><h3 id="header_16" class="form-header">Donation</h3><div id="subHeader_16" class="form-subHeader">Optional</div></div> </li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Amount </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input"> <div class="form-multiple-column" data-columns="3"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_12_0" name="q12_input12" value="18.00" /><label for="input_12_0"><span>$18.00 CAD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_12_1" name="q12_input12" value="36.00" /><label for="input_12_1"><span>$36.00 CAD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_12_2" name="q12_input12" value="54.00" /><label for="input_12_2"><span>$54.00 CAD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_12_3" name="q12_input12" value="180.00" /><label for="input_12_3"><span>$180.00 CAD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q12_input12" id="other_12" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q12_input12[other]" data-otherhint="Other" size="15" id="input_12" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Total </label></div><div id="cid_17" class="form-input"> <div id="total_amount">$0.00 CAD</div> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Payment </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div></div><input type="hidden" name="q13_payment[cc_type]" id="input_13_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q13_payment[cc_number]" id="input_13_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_13_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q13_payment[cc_nameOnCard]" id="input_13_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_13_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card "><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q13_payment[cc_exp_month]" id="input_13_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_13_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q13_payment[cc_exp_year]" id="input_13_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_13_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr></tbody></table> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center; text-indent:156px;" class="form-buttons-wrapper button-align-auto"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="5483384" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "5483384-5483384";</script><div>


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