On the ___________day of the week, the_________________of the month of_________, in the year Five Thousand Seven Hundred and ______, corresponding to the__________ day of the month of _______, in the year of _____________, in ____(city)_____,___(state)_____, the bridegroom, ______________________, said to the bride, _______________: "Be my wife according to the laws and traditions of Moses and Israel. I will work, honor, feed and support you in this custom of Jewish men, who work, honor, feed and support their wives faithfully. I will give you the settlement of ____________ silver pieces that is due you according to Torah law, as well as your food, clothing, necessities of life, and conjugal needs, according to the universal custom." _____(bride)______ agreed and became his wife. This dowry that she brought from her father's house, whether in silver, gold, jewelry, clothing, home furnishings or bedding, ____(groom)_____, the bridegroom, accepted as being worth _____________silver pieces. The bridegroom added an additional _________silver pieces towards the above. The entire amount is the ___________ silver pieces. ____(groom)_____, the bridegroom, made this declaration: "The obligation of this marriage contract, this dowry, and this additional amount, I accept upon myself and my heirs after me. It can be paid from the entire best part of the properties and possessions that I own under all the heavens, whether I own them already or will own them in the future. All of them shall be mortgaged and bound as security to pay towards this marriage contract, and this dowry. It can be taken from me, even from the shirt on my back, during my lifetime, and after my lifetime, from this day and forever." We have made a kinyan for _______(groom)________, the bridegroom, with respect to ________(bride)_______, the bride, regarding everything written and stated above, with a document that is fit for such kinyan. And everything is valid and binding.

Bridegroom_________________
Bride______________________
Witness____________________
Witness____________________
Rabbi/Officiant______________