Quickie QM-7 Series Single Powered Tilt AADL - W581

Size: px
Start display at page:

Download "Quickie QM-7 Series Single Powered Tilt AADL - W581"

Transcription

1 Quickie QM7 Series Single Pwered Tilt AADL W581 EIPW11, Octber 2018 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,Prvince,Pstal Cde: Phne: Optin # Definitin Price Optin # Definitin Price 1. QUICKIE QM7 Series SinglePwer Tilt Seating (Select One) QUICKIE QM710 SC Quickie QM710 SC fr ASAP II Tilt(Fig 1.1) 172PC68 Base Package $7, $7, QUICKIE QM715 HD SC Quickie QM715 HD SC fr ASAP II Tilt $8, PC80 Base Package $8, QUICKIE QM720 SD Quickie QM720 SD fr ASAP II Tilt (Fig 1.1) $8, PC86 Base Package $8, SC Seating Specificatins Typical Chair Weight Transit Seat Type ISO ccupied apprved ASAP II Seat size range Width 12"22" STFH range ASAP II 16.6" 20.6" Pwer Seating Optins W/battery 350 lbs W/O Battery Depth 12"22" 260 lbs 50º CG tilt Pwer Swing away Elevating/Articulating Legrest Pwer Elevating/Articulating Centermunt 12" Seat elevatr Actuatrs Required by Pwer Seating Functin 50º CG tilt 1 actuatr 12" Seat Elevate: 1 actuatr Pwer Leg Functin (Centermunt r Swing away): 2 actuatrs Cmbinatin : Tilt and Seat Elevate: 2 actuatrs Cmbinatin : Tilt and Pwer Elevating Legrest. (Centermunt r Swing away): 3 actuatrs Cmbinatin : Tilt, Elevate and Pwer Legrest (Centermunt r Swing away): 4 actuatrs QUICKIE QM710 Base Specificatins Drive Wheel Psitin Midwheel Drive Drive Wheels 14" Drive Wheels w/ t free insert (Black r Grey) User weight Cap 300 lbs 400 lbs Tires/Casters 6" Frnt / 6" rear (Black r Grey) Base size Width 25" Length 36" Turn Radius 20" Charger 8A Dual Mde Charger (Cmpact) CTE Drive Cntrl RNet PM120 (NnExpandable and Expandable) Battery Size Grup 24 / Grup 34. Driving Range Up t 13.5 miles Shrud Clrs 12 standard clrs, 6 upgrade prints. Drive Mtrs 4ple 6 mph, Optinal 5mph and 8mph Grund Clearance 4" ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 1

2 2. BASE CHAIR OPTIONS Speed Package (4ple) 172PF85 172PF91 172PF90 QM710 Standard 6 mph mtr package QM710 5 mph High Trque mtr package QM710 8 mph Cmmunity mtr package $1, Drive Wheel 172DW59 14" Cast Wheel Slid Dual Density Inserts Black Knbby Tires and Black Caster Std 172PF84 QM715 HD Standard 5 mph mtr package 172PF89 QM720 Standard 8 mph mtr package Suretrac Drive Tracking 172MI01 Suretrac Mdule and Mtr Encders $1, EZ10 Pearl Pink 172WL42 Wheel lcks $ EZ14 Carbn Fiber Print 172FA10 172HT44 Psitin "0" +.5" STFH 172WG06 Less than 150lbs 172HT45 +1" STFH 172WG lb 172HT47 +3" STFH Shrud Clr 172EZ01 172EZ02 172EZ03 172EZ04 172EZ05 172EZ11 172EZ12 172EZ13 172WG13 172EZ18 Grunge Skulls User weight Silver Cpper 172EZ17 Pink Cam Candy Blue Midnight Blue 172EZ15 Pearl White lb 172WG lb 172WG lb Transit Package NA 172WG lb 172EZ07 Wdland Cam. 172EZ16 High Glss Black 172EZ08 Green Apple 172EZ09 172EZ06 Candy Apple Red Yellw Candy Purple Matte Black Digital Cam. American Flag. Transit Optin 172TO25 172TO40 Wheel lcks Ventilatr Optins Seat Height (Use STFH Matrix belw) 172HT49 172HT46 LED Light Package 4Pint Transit Tiedwn Package Meets ISO7176 fr Occupant Use Omit Transit Tiedwn 0 (Measured in the frnt) Obtain Qute t verify est. STFH +2" STFH Requires Grup 34 Batteries LED Light Package: Includes headlights, tail lights, turn indicatrs and flashers. $ VT4 Fixed Vent Tray (Pulmnetic LTV Mdels) $ PreSet Seat Frame Angle 172LI04 $1, Seating Type and Pwer Optin Cmbinatins STFH Matrix SC ASAP II Tilt nly 16.6 SC ASAP II Tilt and 12" Lift cmb " SC ASAP II HD Tilt nly SeattFlr Height at 0 tilt +1" STFH measured with batteries but n user. Actual STFH may vary by.5" *Adding seat angle will increase STFH by 1" fr each incremental change. **Ultra lw STFH may cause grund clearance f Pwer Centermunt t drp belw 2" " +3" BATTERIES and CHARGERS Batteries 172AG21 GP22 Flat Tp Batteries Pair w/strap $ Battery Charger 172BJ19 8A Dual Mde (Cmpact) CTE 172AG04 GP24 MK Gel Flat Tp Batts Pair w/strap Recmmended fr Max Daily Range $ AG22 GP24 Brightway AGM Flat Tp Batteries Pair w/strap. $ AG11 GP34 MK Gel Flat Tp Batteries (Pair) w/straps, Required fr lwer STFH. $ AG23 GP34 Brightway AGM Flat Tp Batts (Pair) w/straps, Required fr lwer STFH. $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 2

3 4. ELECTRONICS Drive Cntrl Optins NnExpandable Cntrllers 172ER05 Expandable Cntrllers 172ER06 RNet Expandable Drive Cntrl (120A) 172EX05 Expandable 120A Cntrller Rnet 172EX06 Harness fr 120A Expandable Cntrller Rnet Jystick RNet NnExpandable Drive Cntrl 120A (Fr Use w/ 2 Thrudrive seat Functins) 172J70 Std LED Jystick fr Rnet Cntrls 172J95 Omit JS. Fr use with OMNI $1,098.0 Rnet OMNI and Output Optins 172ON6 172ON7 172ON8 (Fr expandable cntrls, chse all that apply) $2, Rnet Output Mdule (ECM) $1, Rnet OMNI Input Cntrl Mdule and display with built in Infrared and armrest munt. Chse munt belw. (required fr Specialty Input Devices.) Rnet Bluetth Musemver fr Windws / Andrid $1, ON9 Rnet Bluetth fr Apple Devices $1, Jystick Munt(Fixed, SwingAway, Retractable, Midline) 172JM10 172JM11 172JM15 172JM14 172HM1 172HM2 Fixed Munt Swing Away Munt Retractable Jystick munt w/45º stps Mid Line Munt Jystick Munt (Lcatin) Height Adjustable. Right hand munt Left hand munt Jystick Handle (Optinal) 172JH1 Ball Handle 172JH2 Fam Ball Handle 172JH4 THandle 172JH6 Galpst $ $ $ OMNI Munt (If used with Jystick must be munted ppsite side) 172DS04 Swing Away Left Side OMNI Munt 172DS03 Swing Away Right Side OMNI Munt Switch inputs fr Jysticks r OMNI Drive r Mde / Prfile Cntrl 172SW22 Stere t 2 Mn Splitter $ SW6 Ribbn Switch $ SW1 Buddy Buttn Switch 172SW2 Disc Switch $ SW9 Wbble Switch $ SW4 Micr Light Switch $ SW24 Egg SwitchBlack 172SW21 Dual tggle switch and bracket $ SW35 Switchit Mini 1 buttn n Mn plug $ SW36 Switchit Mini 2 buttn n 2 Mn plugs $ SW37 Switchit Mini 2 buttn n 1 Stere plug $ SW38 Switchit Mini 4 buttn n DB9 cnnectr $ Attendant Cntrl 1720A04 Attendant Cntrl fr Rnet Attendant Munting lcatin 172DN1 172DN2 Munting lcatin: Right Back Cane Munting Lcatin: Left Back Cane $1, Switch Munt Bracket 172EM01 Single Switch Munt Bracket $ Rnet Electrnic Prgrammer 172PR5 Rnet PC Prgrammer with Dngle $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 3

4 Requires expandable Rnet cntrls and OMNI unless therwise nted. Nt available with Uphlstered backs. 5a. Prprtinal Cntrl Packages Head Cntrl Prprtinal Packages Chin Cntrl Prprtinal Jystick Packages Switchit Dual Pr Prprtinal Head Cntrl with Whitmyer and Facial Pads (Adult) 5. Specialty Driver Cntrl Optins $6, Switchit VersaGuide Chin Cntrl Cmpact Jystick and Egg Switch Package $2, ID72 172IJ09 Switchit VersaGuide Cmpact Jystick Midline with Gatlin Package 172IM08 Switchit MicrPilt Jystick with Space Disc Package $4, IJ08 S/A SpaceDisc munt $ Switchit MicrGuide Jystick with SpaceDisc Package Switchit Dual Pr Head Cntrl w/facial pad (Adult) SA Bm Munt with Egg Switch Cntrl $ Switchit Dual Pr Prprtinal Head Cntrl with Spt Pads Package 172ID70 172IJ09 Switchit VersaGuide Cmpact Prprtinal Jystick Switchit VersaGuide Cmpact Prprtinal Jystick Dual Flex Prximity Switches (requires n frce) ASL Micr Mini Jystick w Hand Pad (ASL136) Midline with Gatlin Package $1, $ IJ07 S/A Gatlin Munt $ IJ08 $4, IJ07 S/A Gatlin Munt $ ASL Mushrm Jystick (ALS135) Midline with Gatlin Package Switchit Dual Pr Head Cntrl w/spt pads SA Bm Munt with Egg Switch Cntrl $ Hand Cntrl Prprtinal Jystick Packages 172IJ07 S/A Gatlin Munt $ Switchit VersaGuide Cmpact Jystick Midline and prx flex switches with Gatlin Package S/A SpaceDisc munt ASL Prprtinal Micr Extremity Jystick (ASL130) Midline with Gatlin Package $6, $6, $6, $3, ID63 MicrGuide Prprtinal Jystick $4, $4, ID59 Micr Extremity Jystick $4, IJ07 S/A Gatlin Munt $ SwitchIt MicrPilt Bib Chin Cntrl with Egg Switch Package $4, ASL Cmpact Jystick w Integrated buttns (ASL134) Midline Std 6" $1, with Gatlin Package 172ID62 MicrPilt Prprtinal Jystick $3, ID61 ASL Cmpact Jystick $1, IM05 Bib munt Small $ IJ07 S/A Gatlin Munt $ $4, ID68 Micr Mini Jystick $3, IJ07 S/A Gatlin Munt $ Bib munt Small $ IJ04 SA Bm Munt with egg switch $ Switchit VersaGuide Cmpact Prprtinal Jystick 172IJ04 SA Bm Munt with egg switch $ SwitchIt MicrPilt Bib Chin Cntrl with Egg Switch Package Large 8" 172IJ04 SA Bm Munt with egg switch $ SwitchIt MicrGuide Bib Chin Cntrl with Egg Switch Package Std 6" 172ID63 MicrGuide Prprtinal Jystick $4, IM05 Bib munt Small $ IJ04 SA Bm Munt with egg switch $ SwitchIt MicrGuide Bib Chin Cntrl with Egg Switch Package Large 8" 172IM06 Bib munt Large $ IJ04 SA Bm Munt with egg switch $ ASL Prprtinal Micr Extremity Jystick Chin / Lip with Egg Switch Cntrl Package $3, IM06 Bib munt Large $ ID60 Mushrm Jystick $3, IJ04 SA Bm Munt with egg switch $ IM08 SwitchIt VersaGuide Bib Chin Cntrl Cmpact Jystick with Egg Switch Package Std 6" 172IM05 Switchit VersaGuide Cmpact Prprtinal Jystick Dual Flex Prximity Switches (requires n frce) Switchit VersaGuide Cmpact Prprtinal Jystick SwitchIt VersaGuide Bib Chin Cntrl Cmpact Jystick with Egg Switch Package Large 8" 172ID62 MicrPilt Prprtinal Jystick $3, IM06 Bib munt Large $ IM07 172IM07 S/A Munt ff backrest $ SwitchIt VersaGuide Bib Chin Cntrl Cmpact Jystick with Prximity Flex switches Package Std 6" Switchit VersaGuide Cmpact Prprtinal Jystick S/A Munt ff backrest $ IJ04 SA Bm Munt with egg switch $ Switchit VersaGuide Chin Cntrl Cmpact Jystick and Prximity Flex Switches Package 172IM08 172IM08 Switchit VersaGuide Cmpact Prprtinal Jystick Dual Flex Prximity Switches (requires n frce) Switchit VersaGuide Cmpact Prprtinal Jystick Dual Flex Prximity Switches (requires n frce) 172IM05 Bib munt Small $ SwitchIt VersaGuide Bib Chin Cntrl Cmpact Jystick with Prximity Flex Switches Package Large 8" $3, $ $3, $ $3, $ $2, $3, $4, ID62 MicrPilt Prprtinal Jystick $3, IM06 Bib munt Large $ $5, $5, ID63 MicrGuide Prprtinal Jystick $4, $4, ID59 Micr Extremity Jystick $4, IM07 S/A Munt ff backrest $ IJ04 SA Bm Munt with egg switch $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 4

5 ASL Prximity Head Array Package (Adult) $5, Quickie Sip n' Puff System $ ASL Prximity Head Array Package (Ped) SwitchIt Head Array Package 3 Switch Curved (Lng) $5, MH12 Axys Munt & Bracket fr Specialty Cntrls $ IJ09 SA Bm Munt with Egg Switch Cntrl $ IH1 Sip n' Puff Tubing and SA Hardware $ II03 ASL Prximity Head Array (Ped) $5, IJ09 172II13 Switchit Prximity Head Array Lng $5, MH13 Cbra Munt & Bracket fr Specialty Cntrls $ SwitchIt Head Array Package 3 switch curved (Stubby) 172IJ09 SA Bm Munt with Egg Switch Cntrl $ HE79 Plush Pad 8" fr Specialty cntrls $ II04 SA Bm Munt with Egg Switch Cntrl $ IJ09 SA Bm Munt with Egg Switch Cntrl $ Switch Prximity Head Array (N Egg Switch Needed) Chse "Headrest Munt fr Special Cntrls" 5. Specialty Driver Cntrl Optins (cnt.) 5b. Switch Cntrl Requires Headrest and/r Headrest Munt 3 Switch Prximity Head Arrays Chse headrest munt belw Sip N Puff Package Chse headrest and HR munt belw 172II02 ASL Prximity Head Array (Adult) $5, ID34 Sip N' Puff Kit $ $5, IJ10 SA Bm Munt with egg switch $ $5, Multiple Switches. 172IJ06 Extra SA Bm Munt with egg switch #2 $ Headrest Munt fr Specialty Cntrls 172MH14 Linx Munt & Bracket fr Specialty Cntrls $ II14 Switchit Prximity Head Array Stubby $5, Headrest Pad fr Specialty cntrls 172HE80 Plush Pad 10" fr Specialty cntrls $ HE81 Plush Pad 14" fr Specialty cntrls $ E2330 SwitchIt Head Array 5 switch flat $5, Extra Swing Away Head Bm Egg Switch and Munt 172IJ05 Extra SA Bm Munt with egg switch #1 $ SW31 Switchit 3 Naked prximity switches n DB9 cnnectr. (requires OMNI) $3, Single Switches 172SW32 Switchit 4 Naked prximity switches n DB9 cnnectr. (requires OMNI) $3, IB01 172IB02 Ribbn Switch $ Buddy Buttn Switch $ SW33 172SW34 172SW23 Switchit 5 Naked prximity switches n DB9 cnnectr. (requires OMNI) ASL (502) 5Switch adaptr bx n DB9 cnnectr. (fr use with 5 mn switches, nt included) 4way tggle switch buttn DB9 Cnnectr. Includes bracket $4, $4, $ IB03 Disc Switch $ IB04 Wbble Switch $ IB05 Micr Light Switch 172IB06 Egg SwitchBlack $ IB07 Switchit Mini 1 buttn n Mn plug $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 5

6 172ST56 Quickie A.S.A.P II (Adjustable Seating and Psitining) Chse Seat Frame Size Platfrm. 6. SEAT TYPE ASAP II Frame Size Platfrm (each frame is width and depth adjustable within given range. ) 172FU17 Adjustable 12x12 t 16X19 ( A ) 172FU18 Adjustable 16x12 t 20x20 ( B ) 172FU19 Adjustable 18x16 t 22x22 ( C ) 7. SEAT SIZE Seat Size Matrix. Seat type is chsen in sectin 5. A = ASAP II Seat Frame (Adjustable frm 12x12 t 16X19) B = ASAP II Seat Frame (Adjustable frm 16X12 t 20X20) C = ASAP II Seat Frame (Adjustable frm 18X16 t 22X22) Seat Depth ASAP II Seat Width 12" 13" 14" 15" 16" 17" 18" 19" 20" 22" 12" A A A A A,B B B B B 13" A A A A A,B B B B B 14" A A A A A,B B B B B 15" A A A A A,B B B B B 16" A A A A A,B B B,C B,C B,C C 17" A A A A A,B B B,C B,C B,C C 18" A A A A A,B B B,C B,C B,C C 19" A A A A A,B B B,C B,C B,C C 20" B B B,C B,C B,C C 21" C C C C 22" C C C C Seat Width Seat Depth 172R21 12" Seat width () 172RF20 12" Seat depth () 172R22 13" Seat width () 172RF21 13" Seat depth () 172R23 14" Seat width () 172RF22 14" Seat depth () 172R24 15" Seat width () 172RF23 15" Seat depth () 172R5 16" Seat width () 172RF5 16" Seat depth () 172R6 17" Seat width () 172RF6 17" Seat depth () 172R7 18" Seat width () 172RF7 18" Seat depth () 172R8 19" Seat width () 172RF8 19" Seat depth () 172R9 20" Seat width () 172RF24 20" Seat depth () 172R25 22" Seat width () 172RF26 21" Seat depth () 172RF25 22" Seat depth () 24" Seat Width 172VU16 24" Seat width (fixed width, depth is adjustable 16" t 22" deep) N/A with Pwer r manual recline back r sling back uphlstery. JAY Cushin Bundling 8. SEAT CUSHIONS 172JC14 Jay Cushin On Chair Order Chse Cushin in sectin 17c See Order Frm ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 6

7 9. POWERED SEATING Pwer Seating Optins 172PJ7 Quickie SPOT 50 CG Tilt (1 Actuatr) $7, PJ5 Quickie HD SPOT 50 CG Tilt (400lbs weight limit) (1 Actuatr) $7, PA27 Pwered Seat Elevatr (AKA: Pwer Lift) 12" Pwer Seat Elevate fr use with tilt (Must be rdered with SPOT tilt, NA with QM715 HD)(1 Actuatr) $3, Pwer Seating Cntrl Pwered Seating Switch Cntrl Methd (Fr use with pwer seating actuatrs. Switch activatin is standalne and des nt require expandable r thrudrive electrnics. Single Actuatr Switch Cntrl (Tilt) Switch Cntrl 1 actuatr with 172EO10 Dual Tggle 172EO11 172EO19 172EO20 172EO21 172EO12 172EO23 172EO22 Switch Munt Switch Cntrl 1 actuatr with Buddy Buttn Switch Cntrl 1 actuatr with Switchit Mini 1 buttn Switch Cntrl 1 actuatr with Switchit Mini 2 buttn 23 Actuatr Switch Cntrl (Tilt/Legs, Lift/Tilt) Switch Cntrl 23 actuatr with Dual Tggle Switch Cntrl 23 actuatr with 4way tggle Switch Cntrl 23 actuatr with Switchit Mini 2 buttn Switch Cntrl 23 actuatr with Switchit Mini 4 buttn (fr use with switch cntrl pwered seating) 172PM01 Enable Assignable buttns 172EY01 Switch Munt Right 172EY03 Push buttns 172EY02 Switch Munt Left 172EY04 Tggle switches $ $ $ $ Pwered Seating Thrudrive Cntrl Methd. ThruDrive 1 Seat Functin 172EO28 172EO29 Thru Drive 1 seat Functin (Fr perating Tilt thru Jystick.) Includes Ctrl+5 ThruDrive 2+ Seat Functin Pwered Seating Thrudrive Cntrl Optins Assignable Buttns "Assignable Buttn" feature allws fr custmizatin f jystick buttns and/r Ctrl+5 Switches allwing access t varius wheelchair and seating functins. When enabled, chair will be preprgrammed with seating functins assigned t buttns n the jystick. Assignments can be changed via PC Dngle. 172QG01 Thru Drive 2+ Seat Functins: (Fr perating Tilt, lift, pwer legs) Includes Ctrl+5 Ctrl+5 Switchbx Optins Ctrl+5 allws direct cntrl t 5 pwer seating functins (10 ttal switches). Switches can als be used with assignable buttns fr greater flexibility. Bx includes 3Amp USB prt fr charging prtable devices 172QG02 172QG03 Ctrl+5 Switchbx munted behind jystick Ctrl+5 Switchbx munted ppsite jystick Ctrl+5 Switchbx munted n back cane 172QG05 Omit Ctrl+5 $ Ctrl+5 Switch Type $1, $2, $ BACKREST AND BACK OPTIONS Backrest Frame Type 172BT8 172BT98 Manual Angle Adjustable Recline 40 (ASAP (ASAP II Seat II Seat nly) nly) nt width adjustable $ Back Type 172BU76 172BU77 S.P.O.T. Curved Jay SPO Psterir Psitining (ASAP II nly) $ Manual Recline Adjustment Methd Optin Back Cane Height 23". 172BU78 ART SPO Custm Back (ASAP II nly) See appendix 1 See Pg 8 172MN01 Tl 172BU14 Omit Back. 172MN02 Angle Adjustable Backrest Optins 172OD8 172OD9 Knb (NA with Cantilever r dual pst arms.) (NA with Manual recline) NnFlding Backrest Flding Backrest $ Jay 3 Optin (select Omit abve) 172JC08 Jay J3 On Chair Order Chse back, headrest, laterals in sectin 17a,b,c 172BP40 172BP41 Straight Back Pst 172B132 14" 172B36 16" 172B38 18" 172QT03 Shallw (NA with Uphlstery backs.) 172B40 20" Cane Angle Twel Bar Depth 172QT04 Back Cane 8 Bend Back Pst (Avail. nly w/ Uphlstery r J3 Back) Deep (Extends 4" frm back canes fr deep backs) (Uphlstery Height Measured pan t tp f uphlstery.) Lw (15.5") 172B1 Med (17.5")172B5 Tall (19.5") 172B9 Back Height Required fr SPOT Curved, SPO Backs. (Limited cmbinatins f widths) Measured frm pan t tp f slid back. 172B42 22" 172B44 24" 172B140 26" ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 7

8 11. HEADREST OPTIONS Chse One Each. Headrest Munt Headrest Pad 172MH10 Axys Munt & Bracket $ HE65 Plush Head Supprt Pad 8" $ MH11 Cbra Munt and Bracket $ HE66 Plush Head Supprt Pad 10" $ MH1 Linx Munt and Bracket $ HE78 Plush Head Supprt Pad 14" $ HE82 Adjusta Plush Head Supprt Pad Narrw $ HE83 Adjusta Plush Head Supprt Pad std $ POSTURAL SUPPORTS LATERAL THORACIC SUPPORT (Swing Away) Available n all Slid Backs. LAT 4X4 S/A MOUNTS W/ 1" OFFSET PR 172ZV14 LATERAL 4X4 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR LAT 4X5 S/A MOUNTS W/ 1" OFFSET PR 172ZV15 LATERAL 4X5 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR LAT 4X6 S/A MOUNTS W/ 1" OFFSET PR 172ZV16 LATERAL 4X6 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR LAT 6X4 S/A MOUNTS W/ 1" OFFSET PR 172ZV17 LATERAL 6X4 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR LAT 6X5 S/A MOUNTS W/ 1" OFFSET PR 172ZV18 LATERAL 6X5 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR LAT 6X6 S/A MOUNTS W/ 1" OFFSET PR 172ZV19 LATERAL 6X6 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR CHEST STRAP 172ZR03 E0960 Padded Chest Strap Swing Away Knee Adductr Supprts Knee Adductr Supprts LEFT (chse Pad and Arm) 172KB7 172KB6 172XX07 Pad Size Pad Size SPOT Lng Thigh Supprt Left Knee Adductr Pad SM Right Available with Cantilever Arms, NA with Manual Recline Back, Dual Pst, Single Pst r Cantilever w/ 2 pt Lcking arms. 172TV2 172TX1 Available nly with Fixed and Pwer Center Munt Legrests. Nt available with Dual Pst Arm Rests r 2pint Lcking Cantilever Arms 172KB5 172XX04 172XX06 Swing Away Shrt Left Swing Away Lng Left Knee Adductr Supprts RIGHT (chse Pad and Arm) 172KB8 172XX05 Lng Thigh Supprt Left Remvable Munt Right SPOT Lng Thigh Supprt Right 172TV1 Lng Thigh Supprt Right 172TX2 Knee Adductr Pad SM Left Knee Adductr Pad LG Left S/A Arm Size Knee Adductr Pad LG Right S/A Arm Size Swing Away Shrt Right Swing Away Lng Right Lng Thigh Supprt w/remvable Munt Remvable Munt Left $ $ $ $ ARMREST AND ARMPAD OPTIONS Cantilever Armrests (Adjustable length arm pad included (chse Pad setting belw, except fr Lw Arm Optin) NA with Manual Recline Back 172EG12 172EG13 172EG10 172EG11 Cantilever Armrest Munting STD Cantilever Arm 9"12" Ht Range Std Lw Cantilever Arm 7"10" Ht Range Dual Pst Armrests (NA with Infinite Seat Depth) (Chse ASAPII pad type and size belw) 172EG09 Shrt Dual Pst Flip Back HT Adj 10"15" Standard Cantilever Arm w/ 2 Pint Lcking Pst. (9"10" Ht Range.) NA w/ seat depths belw 16" Standard Cantilever Arm w/ 2 Pint Lcking Pst. (11"12" Ht Range.) NA w/ seat depths belw 16" Cantilever Armpad $ $ Pad Type / Size Optins fr Dual Pst / Single Pst / Lw Cantilever Left Arm Pad () Right Arm Pad () Single Pst Armrests 172EG14 172EG15 172EG23 172AE01 172AE02 172AE03 172AE04 Single Dual Pst Armrest Munting Single Pst Height Adjustable Std. $ Single Pst Height Adjustable Lw Lng Dual Pst Flip Back HT Adj 10"15" Desk Length Waterfall (10") Full Length Waterfall (14") NA w/lw Cantilever arm Desk Length Standard (10") Full Length Standard (14") NA w/lw Cantilever arm $ $ $ AB01 172AB02 172AB03 172AB04 Pad Setting Optins fr Standard Cantilever Arm Left Arm Pad (Std) Right Arm Pad (Std) 172AE11 Full Length Cantilever (14") 172AB11 172AE10 Desk Length Cantilever (10") 172AB10 ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 8

9 14. HANGERS AND FOOTRESTS Swingaway Hangers NnPwered Swing Away Legrests Sld as Pairs 172H2 172H Swing Away (B) 172H6 90 Swing Away (B) (5.59") Manual ELR S/A (B) (Avail. with Fixed Centermunt, chse belw) Pwer Elevating Legrests (2 Actuatrs) $ Swing Away Pwer ELR w/ Articulatin 172H126 Pair (B ftplates) $3, (N/A fr 12" r 13" wide) Centermunt Legrests NnPwered Center Munt Legrests Fixed Center Munt Legrests (includes ftplate) Plus ptins belw 172H134 Fixed Center ASAP II Munt Shrt 172H135 Fixed Center ASAP II Munt Lng Angle Adjustable Center Munt Legrests fr ASAP II 172H104 Angle adjustable Center munt Med (I) Independent leg length and angle adjustable $ Ftplates Fr Swing Away Hangers 172F HL10 172F HL10 195F LS13 Leg Strap 195LS13 195F279 Omit Ftplate and extensin tube Omit Hangers. 172H144 C Kids Angle Adjust w/leg Strap fr use with 70 hanger (Pair) C Kids Angle Adjust w/leg Strap fr use with 80 and 90 hanger(pair) $ $ F286 Kids Angle Adjustable Ftplate $ E2 Omit Hangers Hanger Extensins. (See range listed in matrix belw) NOTE: Nt all extensin tube will be available; depending n the seat height, sme extensin tube ptins may nt ffer enugh grund clearance. 172E16 High Munt Hanger $ E1 Adult Angle Adjustable Ftplate Leg Strap Shrt Medium $ E5 Lng Ftrest Accessries 1725A01 B Adult Angle Adjust w/heel Lp fr use with 70 hanger and ELR (Pair) Heel Lp B Adult Angle Adjust w/heel Lp fr use with 90 hanger (Pair) Adult Angle Adjustable Ftplate Heel Lp Kids Angle Adjustable Ftplate $ $ $ $ Te Lp (Pair) Only avail n (pt B). $ H108 Pwer Centermunt (2 Actuatrs) 172H IE01 172IE02 172HL14 172DI28 Padded and Adjustable Heel Blck I Angle adj Centermunt Ftplate pair 172F125 Angle Adjustable Ftplates $ Custm Centermunt Optins 172DI26 Pwer Centermunt Ftplate Extensin Optin (Fr ThruDrive Operatin) Centermunt Ftplates 172F DI27 Angle adjustable Center munt Large (I) Independent leg length and angle adjustable Pwer Centermunt ELR w/7.5" Pwer Articulatin (F) Centermunt ftplates plus Custm Optins Belw Enable 7.5" Pwered ftplate extensin fr transfer assist. (Electrnics prgrammed t allw ftplates t be extended with r withut legrest being raised) Disable Ftplate extensin fr transfers. (Electrnics prgrammed t ONLY extend ftplates when legs are raised.) F Centermunt Dual Ftplate and Heel Blck (Pair) (Individually Height (3"19") and Angle Adjustable) CMT Angle Adjustable Ftplates Extra Large Single Ftplate fr Centermunt Ftrest. Size 16"W x 14"D Gell Ft Pads fr XL Single Centermunt Ftplate. Extra Large Pair Curved Calf Pads fr Center Munt Legrests. Fully adjustable $ $3, $ $ $ $67.00 $ $ $ $ LS14 Extra Leg Strap $33.00 Hanger Type Standard High Munt Shrt Medium 70 Swing Away 90 Swing Away Manual ELR S/A Angle Adj Cntrmnt Lwer Leg Length Matrix (measured seat pan t the tp f the ftplate surface) 7"14" 13.5" 16" 16"18.5" 18"20.5" 12.5"17" 14.5"19" 17"21" Pwer ELR S/A 12"14" 14"17" 16.5"19" Fixed Cntrmnt ASAP 12.5"15.5" 14.5"19.5" Pwer Cntrmnt 3"19" 5.59" Ftplate munts t frnt f hanger. Lng 3"13" 3"15" Ftplate Matrix B F I J X X X X Single Ftplate X X X ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 9

10 15. ACCESSORIES Wheelchair Tray Table Psitining Belt Select fr any style seat 1727A01 TRAY TABLE SM TUFFAK 12"14" PWR $ EJ01 Aut Style Buckle 1727A02 TRAY TABLE MED TUFFAK 15"17" PWR $ EJ02 Belt 2" Aircraft Buckle $ A03 TRAY TABLE LRG TUFFAK 18"20" PWR $ EJ03 Belt 2" Aircraft Buckle Padded $ Backpack 172A1 Black Utility $ Accessries 1728A A A A12 Ram Phne Munt n Rund JS tube $69.00 Ram Tablet Munt n Rund JS tube $ Ram Cup hlder $69.00 Switchit Remte Stp Switch $1, CUSTOM OPTIONS Lking fr mre ptins? Cntact ur custm "built 4 me" department. T Inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3 r Fax: (800) ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2018 Sunrise Medical Canada Inc. MK REV 9 Page 10

Zippie ZM-310 Group 3

Zippie ZM-310 Group 3 Zippie ZM310 Grup 3 K0848, K0856 EIPW22, January 2019 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,State,Zip: Phne: a Optin # The HCPCS CODES prvided are based n cde verificatin thrugh

More information

Quickie Pulse 6 Group 3

Quickie Pulse 6 Group 3 Quickie Pulse 6 Grup 3 (, K0849, K0856) EIPW22, February 13, 2012 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,State,Zip: Phne: The HCPCS CODES prvided are based n cde verificatin thrugh

More information

Quickie QM-7 Series Single Powered Tilt Seating K0856, K0848, K0877 EIPW11, March 2018

Quickie QM-7 Series Single Powered Tilt Seating K0856, K0848, K0877 EIPW11, March 2018 Quickie QM7 Series Single Pwered Tilt Seating K0856, K0848, K0877 EIPW11, March 2018 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,State,Zip: Phne: The HCPCS CODES prvided are based

More information

Quickie QM-7 Series Non-Powered Seating

Quickie QM-7 Series Non-Powered Seating Quickie QM7 Series NnPwered Seating K0848 / K0850 / K0868 EIPW11, March 2018 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,State,Zip: Phne: The HCPCS CODES prvided are based n cde verificatin

More information

Quickie Pulse 6 BC July 2018

Quickie Pulse 6 BC July 2018 Quickie Pulse 6 BC July 2018 EIPW22 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City, Prvince, Pstal Cde: Phne: a Optin # Definitin Price a Optin # Definitin Price 1. * QUICKIE Pulse 6

More information

Quickie QM-710 Generation 2 Group 3 Powered Seating EIPW11, November 2017

Quickie QM-710 Generation 2 Group 3 Powered Seating EIPW11, November 2017 Quickie QM710 Generatin 2 Grup 3 Pwered Seating EIPW11, Nvember 2017 Accunt: Date: PO#: Buyer: Marked Fr: Ship T: Name: Address: City,State,PC: Phne: a Optin # Definitin Price a Optin # Definitin Price

More information

Quickie QM-715 HD Group 3

Quickie QM-715 HD Group 3 Quickie QM715 HD Grup 3 (K0850, K0858) EIPW11, Nvember 2012 Accunt: Ship T: Date: Name: PO#: Address: uyer: ity,state,zip: Marked Fr: Phne: The HPS ODES prvided are based n cde verificatin thrugh PDA r

More information

Quickie QM-7 Series Power Recline Seating AADL - W581

Quickie QM-7 Series Power Recline Seating AADL - W581 Quickie QM7 Series Power Recline Seating AADL W581 EIPW11, October 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,Province, Postal Code: Phone: Option # Definition Price Option

More information

Quickie QM-7 Series Non-Powered Seating

Quickie QM-7 Series Non-Powered Seating Quickie QM-7 Series Non-Powered Seating January 2019 EIPW11 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,Province,Postal Code: Phone: Option # Definition Price Option # Definition

More information

Quickie QM-7 Series Power Recline Seating

Quickie QM-7 Series Power Recline Seating Quickie QM-7 Series Power Recline Seating July 2018 EIPW11 Account: Ship To: Date: Name: PO#: Address: Buyer: City,Province,Postal Code: Marked For: Phone: Option # Definition Price Option # Definition

More information

Zippie ZM-310 Group 3. EIPW22, July Address: City,Province,Postal Code: 1. Zippie ZM-310 GROUP 3 CATEGORY (Select One) 195PC107 $7,056.

Zippie ZM-310 Group 3. EIPW22, July Address: City,Province,Postal Code: 1. Zippie ZM-310 GROUP 3 CATEGORY (Select One) 195PC107 $7,056. MEDmobility Zippie ZM310 Group 3 5711 Calgary Trail NW Edmonton AB T6H 2K1 P: 7804373300 F: 7804309381 www.medmobility.ca EIPW22, July 2017 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address:

More information

Zippie ZM-310 Group 3

Zippie ZM-310 Group 3 Zippie ZM310 Group 3 (K0848, K0856) EIPW22, February 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification through

More information

Quickie QM-7 Series Non-Powered Seating (K0848 / K0850 / K0868) EIPW11, February 2018

Quickie QM-7 Series Non-Powered Seating (K0848 / K0850 / K0868) EIPW11, February 2018 Quickie QM7 Series NonPowered Seating (K0848 / K0850 / K0868) EIPW11, February 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based

More information

Quickie Pulse 6 Single Power Tilt Seating

Quickie Pulse 6 Single Power Tilt Seating Quickie Pulse 6 Single Power Tilt Seating (K0856, K0011) EIPW22, March 2016 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code

More information

Quickie Pulse 6 Power Recline Seating

Quickie Pulse 6 Power Recline Seating Quickie Pulse 6 Power Recline Seating (Tilt/Recline K0861) (Recline Only K0856) EIPW22, February 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES

More information

Quickie QM-7 Series Power Recline Seating

Quickie QM-7 Series Power Recline Seating Quickie QM7 Series Power Recline Seating (Tilt/Recline K0861, K0862, K0844) (Recline Only K0856, K0858, K0877) EIPW11, October 2017 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip:

More information

Quickie QM-7 Series Power Recline Seating

Quickie QM-7 Series Power Recline Seating Quickie QM7 Series Power Recline Seating (Tilt/Recline K0861, K0862, K0844) (Recline Only K0856, K0858, K0877) EIPW11, January 2017 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip:

More information

Quickie Pulse 5 Group 3 (K0848, K0849, K0011) EIPW22, September 2017

Quickie Pulse 5 Group 3 (K0848, K0849, K0011) EIPW22, September 2017 Quickie Pulse 5 Group 3 (K0848, K0849, K0011) EIPW22, September 2017 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification

More information

ORDER FORM EIPW25. with CAPTAIN'S SEAT. Print pages 1-10 to exclude pictures. Buyer State Zip

ORDER FORM EIPW25. with CAPTAIN'S SEAT. Print pages 1-10 to exclude pictures. Buyer State Zip ORDER FORM Print pages 1-10 to exclude pictures. with CAPTAIN'S SEAT EIPW25 Customer Account # Date PO# Ship To Name Address City Buyer State Zip Mark For Phone Client Measurements a) Top of head to seat

More information

Kids Quickie 2 SE (Without Seating) NOVEMBER 2012

Kids Quickie 2 SE (Without Seating) NOVEMBER 2012 a Mark Fr: Submitting fr: Qute Order ST: Dealer Phne: ( ) Address: Fax: ( ) ZIP: Fax Email Ship T Phne: ( ) Fax: ( ) Optin # HCPCS a Definitin Price Optin # HCPCS Definitin Price KIDS QUICKIE 2 SE W/O

More information

Kids Quickie 2 SE (Without Seating) NOVEMBER 2012

Kids Quickie 2 SE (Without Seating) NOVEMBER 2012 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirmatin Email: Cnfirm Via: Ship T: Attentin: Kids Quickie 2 SE

More information

Quickie QM-715 HD Group 3

Quickie QM-715 HD Group 3 Quickie QM715 HD Group 3 (K0848, K0856, K0861) EIPW11, November 2013 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification

More information

Quickie QM-710 Group 3

Quickie QM-710 Group 3 Quickie QM710 Group 3 (K0848, K0856, K0861) EIPW11, July 2013 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification

More information

Quickie QM-710 Group 3

Quickie QM-710 Group 3 Quickie QM710 Group 3 (K0848, K0856, K0861) EIPW11, November 2013 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification

More information

Kids Quickie 2 SE November 2012

Kids Quickie 2 SE November 2012 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Ship T: Attentin: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirmatin Email: Cnfirm Via: PO#: ZIP: Kids Quickie

More information

Quickie QM-710 Group 3

Quickie QM-710 Group 3 Quickie QM710 rup 3 (K0848, K0856, K0861) EIPW11, Nvember 2012 ccunt: Ship T: Date: Name: PO#: ddress: uyer: ity,state,zip: Marked Fr: Phne: The HPS ODES prvided are based n cde verificatin thrugh PD r

More information

Quickie QM-720 Group 4

Quickie QM-720 Group 4 Quickie QM720 rup 4 (K0868, K0877, K0884) EIPW11, Nvember 2012 ccunt: Ship T: Date: Name: PO#: ddress: uyer: ity,state,zip: Marked Fr: Phne: The HPS ODES prvided are based n cde verificatin thrugh PD r

More information

QUICKIE S646 SE BD/SD/MPD No Power, Single Power & Multi Power Seating Option AADL - W579

QUICKIE S646 SE BD/SD/MPD No Power, Single Power & Multi Power Seating Option AADL - W579 QUICKIE S646 SE BD/SD/MPD No Power, Single Power & Multi Power Seating Option AADL W579 EIS62, October 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,Province,Postal Code: Phone:

More information

Quickie QXi July 2018

Quickie QXi July 2018 Quickie QXi July 2018 EIF6 Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: PV: PC: Address:

More information

SPECIALTY CONTROLS Switch-It Order Form, January 2019

SPECIALTY CONTROLS Switch-It Order Form, January 2019 SPECIALTY CONTROLS Switch-It Order Frm, January 2019 Sld t Accunt Name r #: Buyer: Marked Fr: Qute # Reference: Purchase Order #: Pwer Wheelchair Mfg: Ship t Accunt Name r #: ATTN: Address: City, State,

More information

QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective January 2018

QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective January 2018 QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective January 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS

More information

Quickie QM-7 Series SEDEO Ergo (K0861, K0862, K0844, K0011, K0014) EIPW11, January 2018

Quickie QM-7 Series SEDEO Ergo (K0861, K0862, K0844, K0011, K0014) EIPW11, January 2018 Quickie QM7 Series SEDEO Ergo (K0861, K0862, K0844, K0011, K0014) EIPW11, January 2018 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are

More information

Quickie Qxi November 2016

Quickie Qxi November 2016 Quickie Qxi Nvember 2016 EIF6 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: ADDITIONAL SHIPPING INFORMATION Dealer: Dealer Cntact: Ship T: MEDmbility Reference Only Dealer Address: Attentin:

More information

Quickie IRIS SE. November 2012

Quickie IRIS SE. November 2012 Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: PO#: ZIP: Quickie IRIS SE Nvember 2012 EIZ4-2 Submitting fr:

More information

Quickie 2HP July 2018

Quickie 2HP July 2018 Quickie 2HP July 2018 EIHP Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: PV: PC: Address:

More information

Quickie QM-7 Series SEDEO Ergo

Quickie QM-7 Series SEDEO Ergo Quickie QM7 Series SEDEO Ergo (K0861, K0862, K0844, K0011, K0014) EIPW11, October 2017 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are

More information

Kids Quickie 2 SE January 2018 EIZ10

Kids Quickie 2 SE January 2018 EIZ10 a Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirm Via: ZIP: SUBMITTING FOR: Qute Order Fax Email Ship T Phne: ( ) Fax: ( ) Optin # HCPCS Definitin Price a Optin # HCPCS Definitin Price KIDS QUICKIE 2

More information

Zippie TS SE November 2012 EIZ1A

Zippie TS SE November 2012 EIZ1A Zippie TS SE Nvember 2012 EIZ1A Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer City: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirm Via: Mark Fr: ZIP: Dealer Address: SUBMITTING FOR: Qute Order Ship

More information

Quickie QX February 2019

Quickie QX February 2019 a Mark Fr: Dealer Acct #: Dealer Cntact: Dealer Address: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # Date: Dealer: Dealer City: ZIP: Quickie QX February 2019 EIF6 Fax Email Ship

More information

Zippie 2 January 2018 EIZ2

Zippie 2 January 2018 EIZ2 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirm Via: Mark Fr: ZIP: Zippie 2 January 208 EIZ2 SUBMITTING FOR: Qute Order Fax Email Ship T Phne:

More information

Zippie TS January 2019 EIZ1A

Zippie TS January 2019 EIZ1A a ST: Dealer Phne: ( ) Fax: ( ) 187WM63 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: Cnfirm Via: Mark Fr: 187WM65 187WM64 187WM66 ZIP: SUBMITTING FOR: Qute Order Fax Email Ship

More information

Zippie TS SE January 2019 EIZ1A

Zippie TS SE January 2019 EIZ1A a ST: Dealer Phne: ( ) Fax: ( ) ZIP: SUBMITTING FOR: Qute Order Fax Email Ship T Phne: ( ) Fax: ( ) Flding Grwing Zippie TS SE Withut Seating 187WM67 E1234 Transit Optinal $2,575 True Fit Nt Included Date:

More information

Zippie TS SE January 2018 EIZ1A

Zippie TS SE January 2018 EIZ1A a ST: Dealer Phne: ( ) Fax: ( ) ZIP: SUBMITTING FOR: Qute Order Fax Email Ship T Phne: ( ) Fax: ( ) Flding Grwing Zippie TS SE Withut Seating 187WM67 E1234 Transit Optinal $2,575 True Fit Nt Included Date:

More information

Quickie LXI/LX. January 2019 EILXI/EILX. Address: Ship To City: o Fax o

Quickie LXI/LX. January 2019 EILXI/EILX. Address: Ship To City: o Fax o a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie LXI/LX January 2019 EILXI/EILX Submitting fr:

More information

Orderform Balder Finesse Tilt

Orderform Balder Finesse Tilt Orderfrm Balder Finesse Tilt 74383F_ENG 2007-10-17 Cmpany: Cuntry: Order number: Date f rder: Way f transprtatin: Shipping agent: Custmer Fact Find Custmer infrmatin Custmer name: Assessment date: Assessment

More information

Quickie 2HP January 2017

Quickie 2HP January 2017 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie 2HP January 2017 EIHP Qute Fax Email Ship T

More information

Quickie QXi January 2018

Quickie QXi January 2018 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # ZIP: EIF6 Fax Email Ship T Phne: ( ) Fax: ( ) Definitin

More information

Quickie QXi January 2019

Quickie QXi January 2019 Quickie QXi SUBMIT January 2019 EIF6 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: Dealer

More information

Quickie QRi January 2019

Quickie QRi January 2019 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie QRi January 2019 EIR

More information

Zippie GS SE January 2019 EIZGS

Zippie GS SE January 2019 EIZGS Zippie GS SE January 209 EIZGS Date: SUBMITTING FOR: Qute Order Dealer Acct #: Dealer: PO#: Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP: Address: Dealer Phne: ( ) Fax: ( ) Address:

More information

Zippie GS January 2019 EIZGS

Zippie GS January 2019 EIZGS Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirm Via: Mark Fr: ZIP: Zippie GS January 09 EIZGS SUBMITTING FOR: Qute Order Fax Email Ship T Phne:

More information

Quickie IRIS March 2015

Quickie IRIS March 2015 a Mark Fr: Dealer Acct #: Dealer Cntact: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Optin # 183FS24 ZIP: Quickie IRIS March 2015 EIZ4-2 Submitting fr: Qute Order Fax Email Ship T Phne: ( ) Fax: ( ) a 1.

More information

Quickie 2HP January 2018

Quickie 2HP January 2018 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie 2HP January 2018 EIHP Qute Fax Email Ship T

More information

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models:

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models: Power Portfolio Live Without Limits The Quickie QM-7 series offers a high-performing, reliable, and stylish mid-wheel drive power solution for a client who qualifies for a Group 3 Standard (QM-710), Group

More information

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models:

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models: Power Portfolio Live Without Limits The Quickie QM-7 series offers a high-performing, reliable, and stylish mid-wheel drive power solution for a client who qualifies for a Group 3 Standard (QM-710), Group

More information

Quickie SR45 January 2018

Quickie SR45 January 2018 Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie SR45 January 2018 Address: Address: Ship T City:

More information

Quickie Q7 Adjustable November 2012

Quickie Q7 Adjustable November 2012 a Mark Submitting Fr: fr: Qute Order Dealer Acct #: ST: Dealer Phne: ( ) Address: Fax: ( ) ZIP: Cnfirmatin Email: Ship T City: ST: Cnfirm Via: Fax Email Ship T Phne: ( ) Fax: ( ) Optin # Date: Dealer:

More information

ZM-310. Table of Contents. Why Quickie? Compact Base with Serious Power! Positioning Options. Pediatric Seating

ZM-310. Table of Contents. Why Quickie? Compact Base with Serious Power! Positioning Options. Pediatric Seating Power Portfolio Table of Contents Zippie ZM-310...2 Quickie QM-7 Series...3 Quickie Pulse Series...6 Quickie S-6 Series...8 Quickie P-222 SE...10 PG Drives Technology...12 Back Upholstery Options...12

More information

Quickie 2 Lite. January 2018 EIQ2X

Quickie 2 Lite. January 2018 EIQ2X a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie 2 Lite January 2018 EIQ2X Submitting fr: Ship

More information

Quickie 2 Lite. January 2019 EIQ2X

Quickie 2 Lite. January 2019 EIQ2X Quickie 2 Lite January 2019 EIQ2X a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Qute Fax Email Ship

More information

Quickie Q7 Active Rigid November 2012

Quickie Q7 Active Rigid November 2012 a Mark Submitting Fr: fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirmatin Email: Cnfirm Via: PO#: Quickie Q7 Active

More information

Quickie 2 EIQ2 MASS MASS PLAQUE NO. P

Quickie 2 EIQ2 MASS MASS PLAQUE NO. P Quickie 2 EIQ2 MASS 2009 - MASS PLAQUE NO. P ACCOUNT #: SHIP TO: DATE: NAME: P.O. #: ADDRESS: BUYER: CITY/ STATE: MARKED FOR: POST CODE: PHONE NUMBER: BASE MODEL 113 kgs weight capacity 184WM58 Quickie

More information

Quickie Q7 Adjustable December 2012

Quickie Q7 Adjustable December 2012 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Quickie Q7 Adjustable December 2012 ZIP: Ship T: Attentin: Address:

More information

Zippie Voyage January 2019 EIZ16

Zippie Voyage January 2019 EIZ16 ST: Dealer Phne: ( ) Fax: ( ) ZIP: SUBMITTING F: Qute Order a Optin # HCPCS Definitin Price a Optin # HCPCS Definitin Price 1. FRAME STYLE Designed in cnjunctin with Baby Jgger allwing their patented quick

More information

Zippie Voyage January 2018 EIZ16

Zippie Voyage January 2018 EIZ16 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax:( ) Mark Fr: ZIP: SUBMITTING F: Qute Order The HCPCS CODES prvided are based n cde verificatin thrugh PDAC

More information

Scooters & Power Chairs

Scooters & Power Chairs Scters & Pwer Chairs 91 SCOOTERS SP9000 - TRAVEL MATE SCOOTER Lightweight cmpact design; flds dwn t fit in the back f the car Scratch-resistant plastic Easily adjustable tiller Length Off bard battery

More information

Zippie X'Cape March 2018 EIFZ1

Zippie X'Cape March 2018 EIFZ1 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) ZIP: Ship T City: SUBMITTING FOR: Qute Order Cnfirm Via: Fax Email Ship T Phne: ( ) Fax: ( ) Mark

More information

Zippie X'Cape January 2019 EIFZ1

Zippie X'Cape January 2019 EIFZ1 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) ZIP: Ship T City: SUBMITTING FOR: Qute Order Cnfirm Via: Fax Email Ship T Phne: ( ) Fax: ( ) Mark

More information

Zippie IRIS SE January 2019 EIZ5A

Zippie IRIS SE January 2019 EIZ5A Zippie IRIS SE January 2019 EIZ5A Date: SUBMITTING FOR: Qute Order Dealer Acct #: Dealer: PO#: Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP: Address: Dealer Phne: ( ) Fax: ( )

More information

Zippie Zone January 2019 EIRZ1

Zippie Zone January 2019 EIRZ1 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirm Via: Mark Fr: ZIP: Zippie Zne January 2019 EIRZ1 SUBMITTING F: Qute Order Fax Email Ship T

More information

Quickie IRIS April 2017

Quickie IRIS April 2017 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # ZIP: Quickie IRIS April 2017 EIZ4-2 Qute Fax Email

More information

Quickie IRIS March 2016

Quickie IRIS March 2016 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # HCPCS ZIP: Quickie IRIS March 2016 Qute Fax Email

More information

Quickie Q7 Adjustable August 2015

Quickie Q7 Adjustable August 2015 Quickie Q7 Adjustable SUBMIT August 2015 EIR4 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer

More information

Quickie Q7 Active Rigid January 2018

Quickie Q7 Active Rigid January 2018 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Fax Email Ship T Phne: ( )

More information

JAY J3 Posterior (PA) Backrest

JAY J3 Posterior (PA) Backrest JAY J3 Psterir (PA Backrest Mark Fr: Submitting fr: Qute Order Dealer Cntact: Ship T: Dealer Attentin: Dealer Phne: ( Cnfirmatin Email: Cnfirm Via: Fax: ( Ship T City: Fax Ship T Phne: ( Email Fax:( JAY

More information

September 2016 EIR11 ADDITIONAL SHIPPING INFORMATION

September 2016 EIR11 ADDITIONAL SHIPPING INFORMATION a Mark Fr: Submitting fr: Qute Order Dealer Cntact: Dealer Address: ST: Dealer Phne: ( ) Fax: ( ) Optin # Date: Dealer Acct #: Dealer: Dealer City: Cnfirmatin Email: Cnfirm Via: ZIP: Fax Email Ship T Phne:

More information

Quickie IRIS January 2014

Quickie IRIS January 2014 Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: ST: ZIP: Address: Dealer Phone: ( ) Fax: ( )

More information

Quickie 7 RS October 2015

Quickie 7 RS October 2015 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # HCPCS ZIP: Quickie 7 RS

More information

Quickie 7 R. July 2018 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Option # 1. FRAME 132FF1 132FF2 132FF3. o o o $ $ $150.

Quickie 7 R. July 2018 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Option # 1. FRAME 132FF1 132FF2 132FF3. o o o $ $ $150. Quickie 7 R July 2018 EIR11 Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: PV: PC: Address:

More information

Quickie IRIS FSS Net Order Form/Price List (SIN F-1)

Quickie IRIS FSS Net Order Form/Price List (SIN F-1) Mark For: Date: Dealer Acct #: Dealer: Dealer Contact: Dealer Address: Dealer City: ST: Dealer Phone: ( ) Fax: ( ) Confirmation Email: Confirm Via: ZIP: Quickie IRIS FSS Net Order Form/Price List (SIN

More information

Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg

Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg QUICKIE IRIS Invoice to: Deliver to: Name: Name: Street: Street: Town: Postal code: Town: E-Mail: E-Mail: Tel: Fax: Tel: Order date: Marked for: Purchase order: Number required: Sunrise order no: Base

More information

Quickie IRIS March 2015

Quickie IRIS March 2015 Quickie IRIS March 2015 EIZ4-2 Mark For: Date: Dealer Acct #: Dealer: Dealer Contact: Dealer Address: Dealer City: ST: Dealer Phone: ( ) Fax: ( ) Confirmation Email: PC Please address all correspondence

More information

Quickie Xenon 2 April 2018 EIX2

Quickie Xenon 2 April 2018 EIX2 a Mark Fr: ST: Dealer Phne: ( ) Fax: ( ) ZIP: Qute Fax Email Ship T Phne: ( ) Fax: ( ) Base Mdel Frame Angle Fr sizes 14" r less please use HCPCS E1236 Fixed Frnt & Dual tube nly. See FIGURE 2 107WM96

More information

LIVE OUT LIMITS POWER WITH

LIVE OUT LIMITS POWER WITH POWER You want cutting-edge wheelchair technology to keep pace with the demands of your active life. F over 30 years, QUICKIE has listened, researched, tested and delivered. Through state-of-the-art design,

More information

Quickie Q7 Adjustable January 2018

Quickie Q7 Adjustable January 2018 Quickie Q7 Adjustable SUBMIT January 2018 EIR4 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer

More information

Quickie Xenon 2 January 2019 EIX2

Quickie Xenon 2 January 2019 EIX2 a Dealer Acct #: ST: Dealer Phne: ( ) Fax: ( ) ZIP: Qute Fax Email Ship T Phne: ( ) Fax: ( ) Base Mdel Frame Angle Fr sizes 14" r less please use HCPCS E1236 Fixed Frnt & Dual tube nly. See FIGURE 2 107WM96

More information

Quickie QX December 2018

Quickie QX December 2018 Quickie QX December 2018 EIF6 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV:

More information

Quickie QX July 2017

Quickie QX July 2017 Quickie QX July 2017 EIF6 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: Dealer

More information

Quickie IRIS. January 2019 EIZ4-2

Quickie IRIS. January 2019 EIZ4-2 a Mark Fr: Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # ZIP: Quickie IRIS January 2019 EIZ4-2 Qute Fax Email

More information

Quickie IRIS. January 2018 EIZ4-2

Quickie IRIS. January 2018 EIZ4-2 Mark Fr: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Optin # Date: Cnfirm Via: HCPCS ZIP: Quickie IRIS January 2018 Qute Fax Email

More information

Quickie IRIS SE. January 2018 EIZ4-2

Quickie IRIS SE. January 2018 EIZ4-2 a Mark Fr: Dealer Acct #: Dealer Cntact: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Optin # Date: Dealer: Dealer Address: Cnfirm Via: ZIP: EIZ4-2 Qute Fax Email Ship T Phne: ( ) Fax:

More information

September 2017 EIQ2X. Mark For: Submitting for: o Quote

September 2017 EIQ2X. Mark For: Submitting for: o Quote Quickie 2 September 2017 EIQ2X a Mark Fr: Submitting fr: Qute ST: Dealer Phne: ( ) Fax: ( ) ZIP: Cnfirmatin Email: Ship T City: ST: ZIP: Cnfirm Via: Fax Email Ship T Phne: ( ) Fax: ( ) The HCPCS CODES

More information

Quickie 7 RS March 2018

Quickie 7 RS March 2018 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: Optin # HCPCS ZIP: Fax Email Ship

More information

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2,

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2, Quickie QXi AADL EIF6, October 2018 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City:

More information

JAY J3 Posterior (PA) Backrest E2613 (<22" Wide) January 2017

JAY J3 Posterior (PA) Backrest E2613 (<22 Wide) January 2017 Mark Fr: Submitting fr: Qute Order Dealer Cntact: Dealer Dealer Phne: ( ) Fax: ( ) JAY J3 Psterir (PA) Backrest E2613 (

More information

Quickie 7 R October 2015

Quickie 7 R October 2015 Quickie 7 R Octber 2015 EIR11 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: PO#: Dealer: Dealer Cntact: ADDITIONAL SHIPPING INFORMATION Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP:

More information

LIVE OUT QUICKIE QM-7 LIMITS WITH EXPERIENCE IT ALL. SEDEO Ergo Seating

LIVE OUT QUICKIE QM-7 LIMITS WITH EXPERIENCE IT ALL. SEDEO Ergo Seating EXPERIENCE IT ALL The QUICKIE QM-7 with SEDEO Ergo Seating and SpiderTrac 2.0 suspension redefines powered wheelchair technology, inside and out. Travel further, take on new challenges, and be your independent

More information

Quickie 7 R. January 2019 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact:

Quickie 7 R. January 2019 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Quickie 7 R January 2019 EIR11 Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP:

More information

Quickie 7 R March 2018

Quickie 7 R March 2018 Quickie 7 R March 2018 EIR11 Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP:

More information

Quickie 7 R. January 2018 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact:

Quickie 7 R. January 2018 EIR11. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Quickie 7 R January 2018 EIR11 Mark Fr: Submitting fr: Qute Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: ZIP:

More information