Prequalification form

Nithio Financing Application

Please fill out all fields as accurately as possible to ensure we can appropriately evaluate your application.
Company Details
Company Name *
Company Website *
Company Phone Number *
Company Phone Number

Country Code Area Code Phone Number
Company Email *
Contact Person
Name *

First Name Last Name
Is this person the company CEO? *
Title *
Phone Number

Country Code Area Code Phone Number
Phone Number *
Email *
CEO information

This will be used to send the Non-Disclosure Agreement.
CEO Email *

Financial Information

All financial figures should be provided in USD (United States Dollars).
Revenue for the last 4 quarters *
Last 4 quarters Revenue *
in USD
"EBITDA" negative for the last 4 quarters? *
Absolute "EBITDA" for the last 4 quarters *
"EBITDA" for the last 4 quarters *
EBITDA for the last 4 quarters *
Are you on a clear path to become "EBITDA" positive in the next 18 months? *
Total Liabilities as reported in the most recent period *
"Total Liabilities" as reported in the most recent period *
in USD
Calculation
Total Assets as reported in the most recent period *
"Total Assets" as reported in the most recent period *
in USD
How many years of Audited Financial Statements do you have available? *
How many years of "Operating Track Record" do you have? *
How many years of Operating Track Record do you have? *
Do you have an Integrated 3-Statement Working Financial Model? *
Have you received debt financing in foreign currency (USD/EUR/GBP) in the past? *
What funding amount are you seeking from Nithio? *
What funding amount do you seek? *
in USD
How many years of Audited Financial Statements do you have available?
Additional Financial History

This is required as part of the PUAFF Application.
2023 (YTD) *
2022 *
2021 *
2020 *
Have you ever received any external debt investment? *
Have you ever received any external equity investment? *
Please list all external investors: *
Do you acknowledge that any potential financing from Nithio will be senior secured? *

Confirmation
Please confirm the following statements: *

I acknowledge that this application will allow Nithio to assess my company’s suitability for financing and does not guarantee or imply a commitment to provide funding, nor a representation that such funding will be made available to me or my company. I am aware that Nithio exclusively offers secured financing, and by applying for a loan with Nithio I acknowledge and accept this condition. I acknowledge that the financial figures provided represent the consolidated financials of the company at the main company level. I hereby confirm that the financial figures provided are in United States Dollars and have been calculated using the prevailing FX market rate that is accessible. I hereby confirm that all information I have provided is accurate and correct to the best of my knowledge.
Please verify that you are human *
Should be Empty:

Nithio Financing Application