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
Please enter a valid phone number.
Company Email*
Contact Person
Name*

First NameLast Name
Is this person the company CEO?*
Title*
Phone Number
Please enter a valid phone number.
Phone Number*
Note: The email verification message may take a few minutes to arrive in your inbox. Thank you for your patience.
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 amount of funding 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*
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Nithio Financing Application