Agent Application Form

A. Company Profile & Contact Information

Company Name

Country of Registration

Business Registration Number (if applicable)

Business regions (County and States)

Contact Person – Full Name & Title

Phone Number (including WhatsApp)

Email Address

Business Website (if available)

Years in Operation

Number of Employees

Languages Spoken by Key Staff

B. Business Overview

Type of Business Currently Operated (e.g., Portable Restroom Rental Services)

Estimated Annual Revenue (USD, Approx.)
Less than $200,000$200,000-$500,000$500,000-$10,000,000More than $10,000,000

Storage Capacity (Size / Location)

Number of Portable Restrooms Currently Owned
1-5051-100More than 100Please specify exact number:

Do you have experience importing equipment from abroad?
NoYes

Are you registered on public procurement platforms?
NoYes, please list:

Do you have a growth or expansion plan?
NoYes, please describe:

C. Service & Market Reach

Services Provided (Check all that apply)
Portable Restroom RentalsEvent logisticsConstruction Support ServicesOther, please specify:

Areas/Regions Currently Served

Distribution Capabilities (e.g., delivery range, transport
fleet, response time)
NoYes, please list:

Do you currently work with other brands in this field?
NoYes, please list:

D. Operational Capabilities & Cooperation Intention

Preferred Form of Cooperation (Select one)
Exclusive AgentNon-exclusive DistributorProject-basedOther

Can your company provide local maintenance and/or cleaning services?
NoYesThrough partner.

What type of support can you provide?
On-site setupRemote support onlyBothNot available.

Have you identified seasonal peaks in demand (e.g., festivals, construction,…)? Please specify:

E. Waste Disposal License & Regulatory Compliance

Which regulatory bodies oversee mobile sanitation services in your country?
Municipality / Urban Planning DepartmentMinistry of EnvironmentCivil Defense or Fire Safety Authority.Other:

Are there specific licenses required in your operating area?
No.Yes. Please specify:

Do you currently hold a valid waste disposal license?
No.Yes. Please specify:

Issuing Authority

License Validity Period
From To

Scope of Authorization

F. Rental Interest for Promotional Planning

Number of Portable Restrooms Intended to Rent:

Estimated Rental Duration (e.g., months, years):

G. Customization Preferences & Other Comments

Would you like your company logo to appear on the product?
NoYes

Please specify any customization requests (e.g., color, interior layout, additional features) or submit any questions, clarifications, or proposals below

H. Declaration

I confirm that all information provided in this form is accurate and true to the best of my knowledge.
I understand that this application does not constitute a binding agreement.
I agree to comply with GIGONE LLC’s agency policies and acknowledge that any disputes shall be governed by the laws of the State of Georgia, USA.
I have read and agree to the GIGONE LLC Compliance Statement
I understand that all submitted information will be handled in accordance with applicable data protection regulations.

Date:

Agent Representative Name (Print):

Signature