Reebono Shel Olam, hareinee noten sach (mention the amount of money you donated for charity) lee’tzedakah, oh shemen le’ma’ohr be’ad sach (count out the amount you are donating) le’iluy nishmatam shel avot ha’olam, Avraham, Yitzchak ve’Ya’akov – u’le’shem nishmat Rabee Meh’eer Ba’al Ha’nes – u’le’shem nishmat kol ha’tzadikim ve’ha’chasidim.
Yeheee ratzon milfanecha Adona-i Eloha-i ve’Elohe-y avotai, ke’shem she’sha’matah et tefee’latam ve’hee’tzaltah otam mee’kol tzarah ve’tzukah ve’aseetah eemahem nisim ve’neefla’oht ge’lu’yim ve’nistarim, ve’ho’tzetah otam me’afeilah le’orah, ken bee’zechutam yehee na she’aht rachamim ve’et ratzon milfa’necha, ve’ta’aseh eemadee (say your full Hebrew name including your mother’s name) ve’im kol amcha beit Yisrael bechol makom she’hem, nisim ge’lu’yim ve’nistarim, ve’tatzeeleinu mi’kol tzarah ve’tzukah me’atah ve’ad olam (mention what the crisis or illness it is that you are praying about. If you are praying on behalf of someone in particular, mention the crisis and the person’s name).
Ve’teetneynee le’chen u’le’chesed u’le’rachamim be’eynei kol ro’ai, u’bee’frat etzel (mention the person’s name again who is undergoing crisis). Ye’hee’yu le’ratzon eemrei fee, ve’hegyon leebee le’fanecha, Adona-i tzuree ve’go’a’lee.