By completing, you certify that the information provided is accurate and re-affirmed by my signature above. By completing, you authorize representatives of Blissful Mattress to assist you in credit applications in person at the designated location indicated above. I understand additional details will be needed to proceed at the designated time, date and location indicated above. *DO NOT include critical personal data on this form, including Credit/Debit Card, or bank account information or Social Security Numbers. By completing this form, you authorize Blissful Mattress to communicate with you digitally. Unsubscribe at any time.