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 (incl. WhatsApp)

Email

Business Website (if available)

Years in Operation

Number of Employees

Languages Spoken by Key Staff

B. Business Overview

Type of Business Currently Provided (e.g., Portable Restrooms Rental Services)

Estimated Annual Revenue (USD, Approx.)
< $200K$200K–500K$500K–10M> $10M

Storage Capacity (Size / Location)

Number of Portable Restrooms Currently Owned
1-5051-100>100

Do you have experience importing equipment from abroad?
YesNo

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

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

C. Service & Market Reach

Services Provided (Check all that apply)
Portable Restroom RentalsEvent logisticsConstruction SupportOther

Regions/Areas You Serve

Distribution & Delivery Capabilities

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

Client Experience (Check all that apply)
Government projectsVIP ClientsRoyal FamilyNone

Have you observed any peak demand seasons? If yes, please describe:

Does climate impact restroom operation?
NoYes, describe below:

Can you handle local storage/logistics?
YesNo

D. Operational Capabilities & Cooperation Intention

Preferred Form of Cooperation
Exclusive AgentNon-exclusive DistributorProject-basedOther

Can you provide local maintenance/cleaning services?
YesNoThrough partner

Can you provide on-site setup?
YesNo

Can you provide remote technical support?
YesNo

E. Waste Disposal License & Regulatory Compliance

Regulatory Bodies Overseeing Your Sector (Check all that apply)
MunicipalityEnvironment MinistryCivil DefenseOther

Are specific licenses required?
NoYes, please specify below:

Do you hold a valid waste disposal license?
NoYes, License No.:

Issuing Authority

License Validity Period
From To

Scope of Authorization

F. Rental Interest for Planning Purposes

How many Portable Restrooms are you interested in renting?

Rental Duration (months/years)

G. Customization or Comments

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

Please describe any customization requests (e.g., color, layout, features), or share questions, proposals, or clarifications below:

H. Declaration

I confirm that all the above information 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 information will be processed in accordance with applicable data protection laws.

Date:

Agent Representative Name (Print):

Signature