C350 PS VR2. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements
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1 list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal code: City: Country: Phone: Client Measurements Weight: Height: 1) Upper leg length: 2) Chest Depth: 3) Seat pan to elbow: 4) Arm pit height: 5) Top of shoulders: 6) Top of head: 7) Elbow to Hand: 8) Chest width: 9) Knee to Foot: 10) Hip width: kg All specifications and prices are subject to change without notice. Please note that displayed prices are only valid if ordered with the wheelchair. Any parts ordered for service or future alterations will carry different prices and warranty. Rabobank Parkstad Limburg Rekening: IBAN: NL84RABO BIC/SWIFT: RABONL2U Permobil Europe B.V. De Doom 22 NL 6419 CX HEERLEN Phone: +31 (0) Fax: +31 (0) Page 1 of 5
2 Chassis Model C350 PS VR2 BASIC EUR 4, C350 PS VR2 ADVANCED EUR 4, User manual USER MANUAL ES C350 EUR - User manual seat USER MANUAL ES PS SEAT EUR - Colour covers COVERS C350 BLACK EUR COVERS C350 DARK BLUE METALLIC EUR COVERS C350 RED EUR COVERS C350 SILVER METALLIC EUR COVERS C350 YELLOW EUR - Hub cap HUB CAP INCL. REFLECTOR BLACK EUR HUB CAP INCL. REFLECTOR DARK BLUE METALLIC EUR HUB CAP INCL. REFLECTOR RED METALLIC EUR HUB CAP INCL. REFLECTOR SILVER METALLIC EUR HUB CAP INCL. REFLECTOR YELLOW EUR - Front wheels WHEELS 2.5-3" SOLID TIRES EUR - Rear wheels WHEELS 3.00x8" AIR FILLED TIRES EUR WHEELS 3.00x8" SOLID TIRES EUR WHEEL " MUD/SNOW AIR TIRE (1 pair) EUR Drive parameters PROGR.SET: C350 VR2/70A ADVANCED 8 KMH EUR PROGR.SET: C350 VR2/70A BASIC 8 KMH EUR - Accessories chassi Batteries BATTERIES, 60Ah, SET OF 2 EUR - Charger CHARGER PERMOBIL 24V/8A EU EUR - Light kit (+) LIGHT KIT C350/VR2 EUR _Curb Climber (+) CURB CLIMBERS KIT C 350 EUR Chassis adaption for Permolock C3 (+) ADAPT C300/350 FOR PERMOLOCK C3 EUR Reinforcement chassis for Permolock (+) REINFORCEMENT C350 CHASSIS FOR PERMOLOCK C3 EUR - Seat assembly Seat lift system POWERED SEAT LIFT 200MM C350 / VR2 EUR 1, POWERED SEAT LIFT 200MM C350 (COMB. WITH TILT) EUR 1, SEAT TUBE FIXED C300/C350 EUR SEAT TUBE FIXED C/K300 C350 (COMB. WITH TILT) EUR - Seat tilt options (+) POWERED ADJ.SEAT TILT 30 VR2 EUR 1, Crush gard seat tilt (+) CRUSH PROTECTION SEAT TILT EUR - Seat Page 2 of 5
3 Model SEAT PS EUR - Seat depth SEAT DEPTH SET TO 410MM PS EUR SEAT DEPTH SET TO 435MM PS EUR SEAT DEPTH SET TO 460MM PS EUR SEAT DEPTH SET TO 485MM PS EUR SEAT DEPTH SET TO 510MM PS EUR SEAT DEPTH SET TO 535MM PS EUR - Seat width SEAT WIDT SET TO 400MM PS EUR SEAT WIDT SET TO 450MM PS EUR SEAT WIDT SET TO 500MM PS EUR SEAT WIDT SET TO 550MM PS EUR - Seat cushion (+) SEAT CUSHION 450x560 TEXTILE (MESH) EUR SEAT CUSHION 450x560 VINYL EUR WITHOUT SEAT CUSHION EUR Backrest BACKREST ADJUSTABLE PS 400MM EUR BACKREST ADJUSTABLE PS 450MM EUR BACKREST SOLID EUR - Backrest cushion (+) BACKREST CUSHION 390x535 VINYL EUR BACKREST CUSHION 440x535 VINYL EUR BACKREST CUSHION SOLID BACK VINYL 400MM EUR BACKREST CUSHION SOLID BACK VINYL 450MM EUR BACKREST CUSHION SOLID BACK VINYL 500MM EUR BACKREST CUSHION SOLID BACK VINYL 550MM EUR WITHOUT BACKREST CUSHION EUR Mounting set armrests (+) MOUNTING KIT ARMRESTS EUR - Armrest bracket right AMREST ADJUSTABLE RIGHT EUR - Armrest bracket left AMREST ADJUSTABLE LEFT EUR - Armrest Right ARMREST 350MM,RIGHT VINYL (PU FOAM) EUR ARMREST 400MM,RIGHT TEXTILE (BLACK TRIVERA) EUR ARMREST 400MM,RIGHT VINYL (PU FOAM) EUR ARMRESTS NARROW 267MM RIGHT EUR ARMRESTS NARROW 355MM RIGHT EUR - Armrest Left ARMREST 350MM,LEFT VINYL (PU FOAM) EUR ARMREST 400MM,LEFT TEXTILE (BLACK TRIVERA) EUR ARMREST 400MM,LEFT VINYL (PU FOAM) EUR ARMRESTS NARROW 267MM LEFT EUR ARMRESTS NARROW 355MM LEFT EUR - Armrest adapter (+) ARMRESTS ADAPTER PS EUR - Legrest LEGREST CENTER MOUNTED EUR LEGREST SWING AWAY KNEE ANGLE 70 PS EUR - Adjustment legrest Midline (+) MANUAL ADJUSTMENT LEGREST EUR - Footplate (+) FOOTPLATES NARROW PS EUR FOOTPLATES NARROW PSJR EUR FOOTPLATES WIDE EUR - Page 3 of 5
4 Accessories seat Headrest (+) HEAD SUPPORT, ADJUSTABLE VINYL EUR Lateral support (+) LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR Thigh support (+) THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR Thigh support bracket (+) BRACKETS FOR THIGH SUPPORTS EUR - Calf support (+) CALF SUPPORTS S 110x90 (B)PU FOAM CENT.LEGR. EUR CALF SUPPORTS S 110x90 (B)TEXT.(MESH)CENT.LEGR. EUR CALF SUPPORTS M 165x120 (J)PU FOAM CENT.LEGR. EUR CALF SUPPORTS M 165x120 (J)TEXT.(MESH)CENT.LEGR. EUR CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR Calf support bracket (+) CALF SUPPORTS BRACKET PS EUR - Seatbelt (+) BELT 2-POINT LARGE NONPAD BODYPOINT INCL BRACK UT EUR BELT 2-POINT LARGE PADDED BODYPOINT INCL BRACK UT EUR BELT 2-POINT MEDIUM NONPA D BODYPOINT INCL BRACK UT EUR BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR SAFETY BELT,AUTOTENSION LONG VERSION EUR SAFETY BELT,BUCKLE EUR SAFETY BELT,AUTOTENSION EUR Mounting position seatbelt (+) MOUNT POS SEATBELT ROLL RIGHT EUR MOUNT POS SEATBELT ROLL LEFT EUR - Mounting kit belt (+) TUBE CLAMP KIT EUR Push handles (+) PUSH HANDLES PS EUR Back pack (+) BACK PACK INCL. HOOKS EUR Bag hooks (+) BAG HOOKS OPEN EUR Crutch holder (+) CRUTCH HOLDER PS PS JR EUR Adjustment backrest (+) MANUAL ADJUST. BACKREST QUICKLOCK PSJR EUR User control User control JOYSTICK VR2 BASIC WIHOUT SEAT/LIGHT BUTTONS EUR JOYSTICK VR2 ADVANCED WITH SEAT/LIGHT BUTTONS EUR - Joystick holder (+) PANELHOLDER PAR. SW. AWAY VR2/R-NET L/R EUR - Mounting position joystick (+) MOUNT POS CONTROLBOX LEFT EUR MOUNT POS CONTROLBOX RIGHT EUR - Bracket joystick holder (+) JOYSTICK BRACKET EUR - Permolock Permolock C3 (+) PERMOLOCK C3 WITH STANDARD SWITCH EUR Page 4 of 5
5 Manual Permolock (+) USER MANUAL ES PERMOLOCK C3 EUR - Release lever (+) MANUAL RELEASE FOR PERMOLOCK C EUR Quicklock holder release lever (+) QUICKLOCK HOLDER RELEASE LEVER EUR Spacer kit (+) SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) PERMOLOCK SNAP IN KIT EUR Seat adapter (+) CAR SEAT ADAPTER PERMOLOCK C3 EUR Wheel bump (+) WHEEL BUMP FOR PERMOLOCK C3 EUR Extension cable Permolock (+) EXTENSION CABLE FOR PERMOLOCK C,C3 EUR Chair Order Policy: For other options and special adaptations, please call Permobil for further details. Please also refer to Permobil s Delivery Policy for further information. Your order cannot be processed without the following: - The client s name - The client s measurements - The client s weight For your ordering, please sign below with date and company stamp. Signature: Date: Company Stamp: An order confirmations will be provided by Permobil summarizing the items selected. Please review this carefully. Page 5 of 5
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Power Wheelchair Retail Prescription Form KITEMAX160718 Tel: 01656 776222 Fax: 01656 776220 JULY 2018 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Account No : Contact No
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By Ormesa New 201 Growth Parkway Angola, IN 46703 U.S Suggested Retail Price List Phone: 800 327 0681 Jan 17 Fax: 260 665 3047 Email: iim@mobility usa.com Quote: P.O. www.mobility usa.com Bill To Dealer:
ATP MOBILITY ASSESSMENT FORM
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Standard Base Price: 539
Manual Wheelchair Retail Prescription Form ACTION3JUNIORSMALL19102018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer
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F3 Corpus. Please send order/quote to fax#: (800) to: * Indicates a Required Field Dealer Information
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F5 Corpus. Dealer Information. Client Information. Client Measurements. * Indicates a Required Field. Prices effective: JAN 01, 2018.
* Indicates a Required Field Dealer Information * Contact: Dealer Code: * Dealer Name: Address: * City: * State: * Phone#: * Fax#: PO#: Email Address: Client Information Permobil recommends that the client
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Manual Wheelchair Retail Prescription Form ACTION3JUNIORBASIC05122018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer
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Base configuration Electromagnetic front caster lock Seating position and center of gravity adjustable Comfort armrests
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SALSA M. Salsa MWD. Base Price 4,733 STANDARD SEAT: FRAME / SEAT SIZE STANDARD SEAT: CUSHION JAY CUSHIONS JAY COMFORT SEAT
Invoice to: Deliver to: Name: Name: Street: Street: Town: Postal code: Town: Postal code: Country: Country: Tel: Fax: Tel: Fax: Order date: Marked for: Purchase order: SALSA M Max. user weight: 140 kg
M3 Corpus. Dealer Information. Client Information. Client Measurements. * Indicates a Required Field. Prices effective: JAN 01, 2018.
* Indicates a Required Field Dealer Information * Contact: Dealer Code: * Dealer Name: Address: * City: * State: * Phone#: * Fax#: PO#: Email Address: Client Information Permobil recommends that the client
STELLAR. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.
C u s t o m e r a n d O r d e r I n f o r m a t i o n Purchase Order * Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Tag v.072318 Shipping Address * * required F r a
F5 Corpus. Dealer Information. Client Information. Client Measurements. * Indicates a Required Field. Prices effective: April 15, 2019.
* Indicates a Required Field Dealer Information * Contact: Dealer Code: * Dealer Name: Address: * City: * State: * Phone#: * Fax#: PO#: Email Address: Client Information Permobil recommends that the client
F5 Corpus. Dealer Information. Client Information. Client Measurements. * Indicates a Required Field. Prices effective: October 01, 2018.
* Indicates a Required Field Dealer Information * Contact: Dealer Code: * Dealer Name: Address: * City: * State: * Phone#: * Fax#: PO#: Email Address: Client Information Permobil recommends that the client