Invacare A4 Titanium Ultralightweight Active Performance Rigid

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1 Price List and Order Form For ease of ordering, contact Customer Service Toll Free at: Fax: To order Literature: Effective July 1, 2008 rev September 22, Company Name Account # Phone P.O. # Date Ship to Name & Address Special Note HCPCS codes are not intended to be, nor should be considered billing or legal advice. Providers are responsible for determining the appropriate billing codes when submitting claims to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail. FRAME SELECTION FRAME TYPE TA4T Titanium Adjustable Rigid Frame (K0005)...3, FRAME MODIFICATIONS TFE Tapered Front End... No Charge VFE "V" Front End... No Charge 1 Seat Width & Depth Availability Depth 14" 15" 16" 17" 18" 19" 20" 22" Width 12" X S S S S S S S 13" X S S S S S S S 14" X X X X X S S S 15" X X X X X S S S 16" X X X X X X S S 17" X X X X X X S S 18" X X X X X X S S 19" S S X X X X S S 20" S S X X X X X X 21" S S S S X X X X 22" S S S S X X X X SEAT WIDTH W12 12'' Wide... No Charge 2 W13 13'' Wide... No Charge 2 W14 14'' Wide... No Charge W15 15'' Wide... No Charge W16 16'' Wide... No Charge W17 17'' Wide... No Charge W18 18'' Wide... No Charge W19 19'' Wide... No Charge W20 20'' Wide (E2201) W21 21'' Wide (E2201) W22 22'' Wide (E2201) SEAT DEPTH SEAT DEPTH D14 14'' Deep... No Charge D15 15'' Deep... No Charge D16 16'' Deep... No Charge D17 17'' Deep... No Charge D18 18" Deep... No Charge D19 19'' Deep... No Charge D20 20'' Deep (K2203) D22 22'' Deep (K2204) "V" Front End provides 1'' larger footplate than Tapered Front End. See detail on last page. 2 Not available on Tapered Front End. SUSPENSION FORK OPTIONS (SOFR ADD 1'' TO SELECTED FSTF & RSTF) SOFR LSS Front & Rear Suspension (4 each) (E1015) SUSPENSION SETTING SET160 Soft Setting (Max. User Weight 160 lb)...no Charge SET300 Firm Setting (Max. User Weight 300 lb)... Standard 4 Adjustable Rigid Frame SEAT-TO-FLOOR HEIGHT FRONT SEAT-TO-FLOOR HEIGHT FSTF17 Front STF Height 17'' (18'' with SOFR)...No Charge FSTF18 Front STF Height 18'' (19'' with SOFR)...No Charge FSTF19 Front STF Height 19'' (20'' with SOFR)...No Charge FSTF20 Front STF Height 20'' (21'' with SOFR)...No Charge FSTF21 Front STF Height 21'' (22'' with SOFR)...No Charge Front Seat-To-Floor Heights* Caster Size 3", 4", 5" 6" 17" 18" 18" 19" 19" 20" 20" 21" 21" *Typical dump is 1". Check Rear Seat-To-Floor Range chart for restrictions. REAR SEAT-TO-FLOOR HEIGHT R '' (15.5'' with SOFR option)...no Charge R15 15'' (16'' with SOFR option)...no Charge R '' (16.5'' with SOFR option)...no Charge R16 16'' (17'' with SOFR option)...no Charge 3 LSS suspension was developed by Invacare and Frog Legs Inc and are manufactured by Frog Legs. 4 Firm setting recommended for active users lb. Must select SOFR for suspension setting. 5 17" FSTF not available with 6" casters 5 For the most current pricing information go to page 1

2 R '' (17.5'' with SOFR option)... No Charge R17 17'' (18'' with SOFR option)... No Charge R '' (18.5'' with SOFR option)... No Charge RR18 18'' (19'' with SOFR option)... No Charge R '' (19.5'' with SOFR option)... No Charge RR19 19'' (20'' with SOFR option)... No Charge R '' (20.5'' with SOFR option)... No Charge R20 20'' (21'' with SOFR option)... No Charge Rear Seat-To-Floor Range* Rear Wheels 22" 24" ** 26" 17 FSTS 14.5" - 16" 15.5" - 17" N/A 18 FSTS 14.5" 17" 15.5" - 17" 16.5" - 18" 19 FSTS 14.5" - 18" 15.5" - 18" 16.5" - 18" 20 FSTS 14.5" - 19" 15.5" - 19" 16.5" - 19" 21 FSTS N/A 15.5" - 20" 16.5" - 20" *SOFR selection raises RSTF range by 1" **For 25" Spingery Spox Wheels, use 24" rear seat to floor height Knee-to-Heel Range Front Seat-to-Floor 17'' 11.25'' 16.25'' 20'' 14.25'' 19.25'' 18'' 12.25'' 17.25'' 21'' 15.25'' 20.25'' 19'' 13.25'' 18.25'' ARM SELECTION ARM TYPE (PAIR) AT99 Swingaway Padded Arms... No Charge TAF T-Arms, Adjustable Height Full Length (E0973) TAD T-Arms, Adjustable Height Desk Length(E0973) T-ARM HEIGHT L6-10 Low Range 6'' - 10'' (T-Arm Height)... No Charge H8-14 High Range 8'' - 14'' (T-Arm Height)... No Charge Arm Heights Top of Seat Rail to Top of Armrest T-Arms Low 6" 10" Adjustable in.5" Increments High 8" 14" Adjustable in 1" Increments Swingaway Standard 9" 11" Adjustable in 1" Increments BACK SELECTION FIXED FOLDDOWN BACK FLDWN Fold-Down Back... No Charge BACK TYPE 7 BACK811 Adj. Ht. Back w/o Push Handles (8'' - 11'')...No Charge BACK1014 Adj. Ht. Back w/o Push Handles (10'' - 14'')...No Charge BACK1216 Adj. Ht. Back w/o Push Handles (12'' - 16'')...No Charge BACK1418 Adj. Ht. Back w/o Push Handles (14'' - 18'')...No Charge BACK1620 Adj. Ht. Back w/o Push Handles (16'' - 20'')...No Charge PH1014 Adj. Ht. Back w/push Handles (10'' - 14'') PH1216 Adj. Ht. Back w/push Handles (12'' - 16'') PH1418 Adj. Ht. Back w/push Handles (14'' - 18'') PH1620 Adj. Ht. Back w/push Handles (16'' - 20'') BACK RIGIDIZER BAR WELD Welded...Standard BLTON Bolt-On... No Charge 6 Rigid side guards included with the T- Arms. 7 ¾" tube telescoping in 1" tube. CASTER & WHEELS CASTER OPTIONS (PAIR) AT900 3'' Roller Blades...No Charge 4SOFT 4'' Semi-Pneumatic Casters SOFT 5'' Semi-Pneumatic Casters AT901 5'' Composite Urethane Casters...No Charge 5ALUM 5'' Aluminum Urethane Casters AT902 6'' Composite Urethane 3 Spoke Casters...No Charge 8 9 6PNEU 6'' x 1.25'' Composite Pneumatic Casters WHEEL OPTIONS (PAIR) 22COM 22'' Composite Wheels...No Charge 10 24COM7 24'' Composite - 7 Spoke Wheels...No Charge 11 22SP 22'' Spoke Wheels...No Charge 24SP 24'' Spoke Wheels...No Charge 26SP 26'' Spoke Wheels SPIN24 24'' Spinergy Spox Wheels SPIN25 25'' Spinergy Spox Wheels SPIN26 26'' Spinergy Spox Wheels HPS 24'' High Performance Spoke Wheels HPS 26'' High Performance Spoke Wheels SPLX24 24'' Spinergy LX Wheels SPLX25 25'' Spinergy LX Wheels FN Sun Fusion 16 Spoke Wheel FN Sun Fusion 16 Spoke Wheel s FN Sun Fusion 16 Spoke Wheel SCF 559 Three Spoke Composite Wheels KNOB 24" Spoke Wheels for Knobby Tires...No Charge 19 L8701 Omit Rear Wheels... Less Spinergy Spoke Color (If color is not chosen, spokes will be black.) SPCY Yellow SPCBK Black SPCW White SPCR Red SPCBL Blue TIRE OPTIONS (PAIR) PNEU Pneumatic Tires...No Charge PNEUFF Flat Free Inserts (pair) (E2213) URETH Urethane (Treaded) Tires PRIMO Primo Tires CRF123 Schwalbe 1 Flat-Resistant Non-Marking Pneu KIKB KIK -Black Tires HANDRIM OPTIONS (PAIR) ALUMPC Aluminum Anodized Handrims... Standard A1512K Black Plastic Coated Handrims Not available with 22" wheels. 9 Only available with "V" Front End. 10 Available with PNEU, PNEUFF, and URETH. 11 Available with PNEU, PNEUFF, URETH and KIKB tires. 12 Available with PNEU, and PNEUFF tires. 13 Spoke wheels come standard with dome, quick-release button axle. 14 Available with PNEU, PNEUFF, PRIMO and KIKB tires. 15 Available with PNEU or PRIMO tires. 16 Available with PRIMO, CRF123 tires. 17 FN1624 available with PNEU, PRIMO, KIKB, CRF123; FN1625 available with PRIMO, KIKB,CRF123; FN1626 available with PNEU, PRIMO, CRF Considered a 24" diameter wheel. 19 Available with KNOBT tires. 20 When choosing omit rear wheels, the frame will be constructed for 24'' wheels. 21 Not available with 3SCF wheels. 22 Not available with 3SCF, SPIN24, SPIN25,SPIN26 wheels. 23 Not available with 24KNOB wheels. For the most current pricing information go to page 2

3 AT Plastic Coated w/8 Oblique Projections AT Plastic Coated w/8 Vertical Projections AT Plastic Coated w/12 Vertical Projections NFSDLT Natural Fit LT Handrims Standard Grip NFSPLT Natural Fit LT Handrims Super Grip NFITSD Natural Fit Handrims Standard Grip NFITSP Natural Fit Handrims Super Grip MOUNTING HANDRIMS IN Mount Inside Handrim... No Charge 28 OUT Mount Outside Handrim...Standard ADDITIONAL DUAL CAMBER INSERT AC00 0 Degree Camber Angle AC03 3 Degree Camber Angle AC06 6 Degree Camber Angle AC09 9 Degree Camber Angle AC12 12 Degree Camber Angle CAMBER INSERT RELEASE TYPE NAB Nut & Bolt... Standard QRL Quick Release Lever (K0108) WHEEL LOCKS (PAIR) A1598 Hill Holder - Clamp-On Wheel Locks (E0974) Push To Lock Wheel Locks... No Charge 29 A1567 Pull To Lock Clamp-On Wheel Locks...No Charge 30 HUMW Hideaway Undermount Wheel Locks L8704 Omit Wheel Locks... Less Overall Width by Camber Angle Wheel Type Spoke 6.75'' 8'' 10'' 12.25'' 14.25'' Composite 7'' 8.25'' 10.25'' 12.5'' 14.5" Add the amount above to the seat width to obtain the overall width at its widest point. CAMBER OPTIONS CAMBER INSERT TYPE SINGLE Single Camber...Standard DUAL Dual Camber... No Charge CAMBER INSERT (MUST CHOOSE 2 W/ DUAL CAMBER) C00 0 Camber... No Charge C03 3 Camber... No Charge C06 6 Camber... No Charge C09 9 Camber... No Charge C12 12 Camber... No Charge DUAL CAMBER INSERT (Must Choose 2) C00 0 Degree Camber Angle... No Charge C03 3 Degree Camber Angle... No Charge C06 6 Degree Camber Angle... No Charge C09 9 Degree Camber Angle... No Charge C12 12 Degree Camber Angle... No Charge ADDITIONAL CAMBER INSERT AC00 0 Degree Camber Angle AC03 3 Degree Camber Angle AC06 6 Degree Camber Angle AC09 9 Degree Camber Angle AC12 12 Degree Camber Angle Available with 24COM7,24SP,24HPS wheels. 25 Not available with 22SP,3SCF,SPIN24,SPIN25,SPIN26 and KNOBT tires. 26 Available with 24COM7. 27 Not available with 22COM, 22SP, 3SCF, 559TS, 3SCF, 24KNOB wheels. 28 Decreases overall width by.75''. 29 Not available with Non-Removable Fold Down Side Guards. 30 Not available with urethane tires. For the most current pricing information go to page 3

4 COLOR SELECTIONS FRAME FINISH 113P Bead Blast... No Charge CONTEMPORARY COLORS 24P Wet Black... No Charge 71P Silver Vein... No Charge 60P Silver Metallic... No Charge 115P Black Prism... No Charge 105P Midnight Blue... No Charge TOO HOT COLORS 30P Sunny Yellow... No Charge 61P Electric Red... No Charge 119P Bubblegum Pink... No Charge 120P Grape Madness... No Charge WAY COOL COLORS 62P Electric Blue... No Charge 121P Lolly Pop Blue... No Charge 122P Cosmic Blue... No Charge 125P Emerald Green... No Charge 127P Grasshopper Green... No Charge 104P Electric Teal... No Charge Touch-Up Paint POSITIONING STRAP SEAT POSITIONING STRAPS A1515 Push Button Seat Positioning Strap (E0978) A1321 Hook & Loop Seat Positioning Strap (E0978) ACCESSORIES BACK ACCESSORIES BACKPACK Back Pack ADJTENS Adjustable Tension Back Upholstery (K0108) Push Handles (Quick Release) (pair) PUSHHANDL Push Handles (Bolt On) (pair) L8601 Omit Back Upholstery... Less SEAT ACCESSORIES SP-01 Seat Pouch L8651 Omit Seat Upholstery... Less MISCELLANEOUS ACCESSORIES A1576 Wheel Lock Extensions 6" (pair) (E0961) A1573 Quad Release Axles (pair) (K0108) A1307 Spoke Protectors (For 20'',22'',24'',26'' (K0065) Rear Anti-Tippers (pair) (E0971) A1209 Tire Pump '' To 1'' Clamp Assembly ARM ACCESSORIES (PAIR) A1571 Fabric Clothing Protectors (K0108) SM Rigid Side Guards, Small (K0108) LG Rigid Side Guards, Large (K0108) SMH Quad Rigid Side Guards, Small (K0108) LGH Quad Rigid Side Guards, Large (K0108) NR Non-Removable Fold Dn Side Guards (K0108) MISCELLANEOUS ACCESSORIES A1576 Wheel Lock Extensions 6" (pair) (E0961) A1573 Quad Release Axles (pair) (K0108) A1307 Spoke Protectors (pair) (K0065) Rear Anti-Tippers (pair) (E0971) A1209 Tire Pump /4'' To 1'' Clamp Assembly FRONT RIGGING OPTIONS FOOTPLATE OPTIONS AT5041 Adjustable Angle One Piece Footboard (K0040)Standard 36 RGDTUB 1 Piece Tubular Footrest...No Charge 36 RGDTUBTI Titanium 1 Piece Tubular Footrest FOOTREST/LEGREST ACCESSORIES FRMPRBK ChairArmor Black Neoprene Frame Protectors FRMPRB ChairArmor Black Neoprene Frame Protectors FRMPRR ChairArmor Black Neoprene Frame Protectors FRMPRS ChairArmor Black Neoprene Frame Protectors BASROLLER Basketball Roller CALFSTRAP Calf Strap (each)...no Charge SEATING SEATING CUSHION SELECTION 37 EC Absolute Cushion (E2601) ITSG InTouch Stabilite Gentle Contour Cushion (E2607) ITSM InTouch Stabilite Max Contour Cushion (E2605) ITFG InTouch Flovair Gentle Contour Cushion(E2607) ITFM InTouch Flovair Max Contour Cushion (E2607) SEATING BACK SELECTION 37 PBR Personal Back 10 Reg. Height *(E2615) PBT Personal Back 10 Tall Height (E2615) PPR Personal Back 10 Plus Reg. Height (E2615) PPT Personal Back 10 Plus Tall Height (E2615) ITPR InTouch Propel Back (E2611) Touch Up Paint not available in all colors. 32 Not available with Undermount Wheel Locks. 33 Used for attaching accessories to wheelchair. Attaches.75" tube to 1" tube. 34 Not available with Undermount Wheel Locks. 35 Used for attaching accessories to wheelchair. Attaches ¾" tube to 1" tube. 36 Only available with Tapered Front End. 37 For additional information (size availability, additional seating options and pricing) see form # Rehab Seating and Positioning Products price list. 38 Available in even sizes only. See form for additional information. For the most current pricing information go to page 4

5 SEATING & POSITIONING FOR YOUR SEATING NEEDS PLEASE REFER TO THE FOLLOWING REHAB SEATING & POSITIONING PRODUCTS See Price List Form Weight Limitation 300 Pounds Invacare recommends all wheelchairs be fitted to the consumer under the guidance of a healthcare professional, knowledge of the particular limitations of the product. Basic Chair Includes Titanium Adjustable Rigid Frame Tapered or "V" Front End Seat Widths (W12 - W19) Seat Depth (D14 - D18) Front Seat-To-Floor Height Selection Fold Down Back Adjustable Height Back w/o Push Handles Back Rigidizer Bar (WELD or BLTON) Frame Finish Caster Options (AT900, AT901 or AT902) Wheel Options (22COM, 24COM7, 22SP or 24SP) PNEU Pneumatic Tires ALUMPC Aluminum Anodized Handrims Rear Seat-To-Floor Height Setting Camber Inserts (SINGLE or DUAL) Camber Angle (C00, C03,C06 or C12) NAB Nut and Bolt Camber Insert Release Calf Strap Slip On Back Upholstery Quick Release Axles Wheel Locks (9691 or A1567) Specifications Frame Style Rigid Seat Widths 12" - 22" Seat Depths 14" - 22" Overall Width 18.75" 36.5" Adjustable Height Back 8" - 20" (See Back Adjustment Category) Adjustable Angle Back -15, -10, -5, 0, 5 Camber Angles 0, 3, 6, 9, 12 Tubing Sizes 1" Titanium Weight Limit 300 lb Weight of Chair 13 lb (15 x 16 without rear wheels and accessories) Warranty Refer to owner's manual Available Through Our Specials Department 3'' Depth Adjustable Frame (Longer Frame w/back Canes Set Forward) SM Caster Swivel Locks SM Flip Up Footplates SM One Arm Drive - 0 Camber SM Amputee Attachment (Longer Frame w/back Canes Set Forward) SM Frog Legs Front Suspension Forks Only SM All specials are subject to final approval. Some special quotes are not compatible for all frame configurations. Please contact Customer Service for details and prices. Foot Space Width FSTF17 5.0" less than seat width FSTF " less than seat width FSTF19 5.5" less than seat width FSTF " less than seat width FSTS21 6.0" less than seat width Invacare Corporation USA One Invacare Way Elyria, OH USA All rights reserved. Trademarks are identified by the symbols and. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. KIK is a registered trademark of KIK Technology, Inc. Spinergy is a registered trademark of Spinergy, Inc., Frog Legs is a registered trademark of FROG LEGS, Inc. Specifications and prices are subject to change without notification Invacare Corporation Form No rev 0909