HeavyBroker | Borrower Intake

Account Executive

Who is submitting this intake?

AE Name *

AE Email *

Borrower Identity

Issuer details and entity structure.

1) Legal name of issuer *

2) Country of incorporation *

3) Entity type *

4) Issuer structure *

5) Does a parent company exist? *

Yes No

6) Issuing entity relative to operating assets *

Country & Macro Exposure

Operating footprint, FX and regulatory considerations.

Business Profile

Industry, revenue profile, and customer concentration.

14) Industry *

15) Years in operation

16) Revenue type

17) Revenue stability

18) Top customer concentration

Management & Governance

Experience, continuity, and board profile.

19) Management experience in operating country

20) Has management operated through a currency devaluation

Yes No

21) Recent management changes in last 12 months

Yes No

22) Board composition

Financials

Statements, standards, and currency profile.

23) Financial statements available

24) Accounting standard

25) Auditor

26) Revenue currency

27) Debt currency

28) EBITDA margin

Capital Structure

Current debt profile and related-party exposure.

Proposed Financing Request

Raise size, structure, tenor, and proceeds.

34) Target raise size (USD)

35) Instrument type

36) Issuance currency

37) Expected tenor

38) Interest type

39) Use of proceeds

40) Will proceeds remain offshore

Yes No

Security & Covenants

Collateral, guarantees, and covenant style.

41) Collateral offered

42) Guarantees provided by

43) Covenant structure

Legal & Compliance

Litigation, sanctions, and compliance checks.

44) Pending litigation

Yes No

45) Tax disputes

Yes No

46) Sanctions exposure

47) FCPA or corruption investigations

Yes No

48) Prior issuance of unregistered securities

Yes No

Investor & Execution

Target investor base and execution readiness.

49) Target investors

U.S. Credit Funds Insurance Companies EM-Dedicated Funds

50) Credit rating status

51) Execution priority

52) Legal counsel engaged

Yes No

53) Offering Memorandum timeline

Loan Programs Requested

Select all applicable financing programs.

International & Offshore Options

Select any applicable international structures.

55) International or offshore financing options

International Bridge Loan Capital Raise Funding Stack Financing Hard Money Loans Purchase Order Financing Invoice Factoring

Final Disclosure

Anything that changes appetite or requires special handling.

56) Any deal-stoppers

57) Any disclosure concerns

58) Key FX political or regulatory risks

Ready to submit?

We'll email the full submission to founders@heavybroker.com.

Borrower Information Form

Account Executive

Borrower Identity

Country & Macro Exposure

Business Profile

Management & Governance

Financials

Capital Structure

Proposed Financing Request

Security & Covenants

Legal & Compliance

Investor & Execution

Loan Programs Requested

International & Offshore Options

Final Disclosure

Ready to submit?