SpectraXTR2 HD (Modulite Flex 3 Seating or MAX System) Dealer Max User Weight 160Kg (25 stone)

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1 Invacare Ltd Power Chair Prescription Form Pencoed Technology Park Dealer Prescription Form Pencoed CF35 5AQ LPF1U2SPECTRAXTR2HD010715DEALER Tel: +44 (0) Fax: +44 (0) July e-spare cat Now Available Online at Customer Name : Account No : Address : Order No : Order Qty : Tel Number : Delivery Address : Order Date : Invacare SpectraXTR2 HD (Modulite Flex 3 Seating or MAX System) Dealer Max User Weight 160Kg (25 stone) Standard Features Rear Wheel Drive base with Strong Suspension Tension adjustable backrest (stepless adjustment, accessible from the rear) Modulite Telescopic adjustable Seat Widths from 480mm - 580mm (19" - 23") MAX seat seat frame 550mm (21.75") (adjustable by armrests mm) Modulite seat depths 410 mm mm Stepless Adjustment (16" - 20") MAX seat depth mm (20" ") Detachable T-Armrests, height, width and depth adjustable with standard armpad Manually settable seat tilt (from 0 to 20 ) and backrest recline (0-30 ) Swing away and detachable legrest hangers with fixed footplate DX2 Control System with REM A joystick 318 x 57 mm (12.5" x 2.25") puncture proof solid inlay grey Drive Wheels 230 x 60mm (9 x 2.4") puncture proof solid inlay, greyfront castors Choice of 4 Chassis Colours 6km/h (4mph) 4 Pole Motors and 40Ah GEL Batteries (range 25 km) 4 Point tie down system: crash tested to ISO7176 part 19 Lapbelt (adjustable both sides) fitted to base of backrest Toolkit and 8A ( V) Charger Standard Base Price: 4,100 * Configurations may vary from the image shown please make your selection with a cross in the box Standard feature Free of Charge Code Description Dealer ASD0001 Basic Model ASX0001 Special Basic Model PLEASE COMPLETE DETAILS AT THE END OF THE FORM POA SEATING TYPE - MODULITE ASD2100 X Modulite Seating Unit (Flex3 seating unit) 4,100 ASD2111 SEAT FRAME AND SEAT PLATE Telescopic Seat Frame with metal seat plate (with stepless adjustment on armrests, legrests and backrest) 1 of 7

2 MODULITE SEAT SIZE SETTING CHART: SEAT DEPTHS Seat Rail mm ASD2132 (16") 410mm ASD2134 (18") 460mm ASD2136 (20") 510mm 330mm* (13") ASD mm (15") SEAT WIDTHS ASD mm (17") ASD mm (19") ASD mm (21") *330mm (13") seat width achieved on a 380mm seat frame (2121) with inrigged armrests (2183) 1. Seat depth 410mm: cannot combine T-Armrests (2191) with flexible lapbelt mount (2113) 2. No seat cushion available with 560mm seat depth (2138) 3. Seat width 530mm (2124) not possible in combination with following armrests (2192/3) SEAT CUSHION (sizes according to seat frame settings) ASD2142 Matrx Flo-tech Lite - pressure relieving seat cushion 92 ASD2140 Without seat cushion BACKREST SUPPORT ASD2162 Backposts 540mm (tall) must be selected for Flex3 laguna backrest ASD2163 Backposts 480mm (short) Tension adjustable backrest only SWO0001 ASD2171 SPECIAL BACKPOST MODIFICATION No push handles (extended leadtime). Push handles will be cut down on the vertical section. If you require a specific length of push handle please note in the specials box at the end of the form. BACKREST UPHOLSTERY / CUSHION Tension Adjustable Backrest (540mm or 480mm upholstery height) Straps easily accessible and adjustable from the rear (maximum seat depth achievable 530mm (21") ) Not available with a tension adjustable backrest in combination with a headrest. Not available with laterals, black nlyon / fabric upholstery only ASD2172 Flex3 adjustable Backrest Plates (without Backrest Cushion) 183 ASD2173 ASD2174 ASD2175 ASD2176 ASD2177 ASD2178 ASD2170 Flex3 adjustable Backrest Plates with Laguna Backrest cushion (maximum seat depth achievable 510 mm (20") ) Matrx Posture Back, height 400mm (Mesh fabric) Matrx posture Back, height 500mm (Mesh fabric) Matrx Elite Back, height 500mm (Mesh fabric) Matrx Elite TR Back, height 500mm (Mesh fabric) Matrx Elite Deep Back, height 500mm (Mesh fabric) Without Backrest Upholstery (Straight 1" diameter Back Posts/Back Frame only suitable for mounting specialist backrests) UPHOLSTERY COLOUR ASD1496 ASD1496 ASD1496, seat width of 380mm (15") ASD2121 in combination with flip up or following armrests ASD1496, seat width of 380mm (15") ASD2121 in combination with flip up or following armrests Not available with Laterals or non Invacare Headrest but profile mount ASD1496 Not available with laterals or non Invacare Headrest but profile mount ASD1496 ASD2151 Black fabric nylon ASD2152 Black Dartex ASD2153 LK Version (black with orange seam) ASD2154 Black Plush of 7

3 ASD2191 SWO0002 ARMREST (NOTE: HIP GUIDES ONLY POSSIBLE WITH FLIP UP ARMRESTS) Single post 'T-Armrest' removable and height adjustable (with stepless positioning relative to the backposts) adjustable in height mm Extended height Single post 'T-Armrest': Range of adjustment from seat plate 295mm to 365mm (extended leadtime) 115 ASD2183 In-rigged Armrests (reduces seat width by 25 mm each side) 20 ASD2193 Flip-up Armrest (height and depth adjustable) Max user weight 150kg Not available with laterals 28 ASD2192 ASD2194 Following Armrest (height adjustable from mm) Max user weight 150kg Following Armrest (height adjustable from mm) Max user weight 150kg ARMPADS ASD2195 Short Armpad (325 mm) ASD2196 Long Armpad (375 mm) ASD2197 Long Ergonomic Armpad (397 mm) ASD2199 Soft Armpad (REA Azalea Wide Pad) T-Armrest 2191 In-rigged armrest 2183 Flip-up armrest 2193 Hip support Short armpad Long ergonomic Following armrest 2192/4 Long armpad Soft armpad HIP SUPPORTS LH (for flip up and following armrests only) ASD2184 Multi adjustable hip support LH, pad size SMALL 140 x 100mm 185 ASD2186 Multi adjustable hip support LH, pad size MEDIUM 230 x 100mm 185 ASD2188 Multi adjustable hip support LH, pad size LARGE 330 x 100mm 185 HIP SUPPORTS RH (for flip up and following armrests only) ASD2185 Multi adjustable hip support RH, pad size SMALL 140 x 100mm 185 ASD2187 Multi adjustable hip support RH, pad size MEDIUM 230 x 100mm 185 ASD2189 Multi adjustable hip support RH, pad size LARGE 330 x 100mm 185 SEAT ACCESSORIES for MODULITE HEADREST/NECKREST (Dartex) ASD1350 Neckrest: height and depth adjustable (Azalea type dartex covered 59 ASD1432 Headrest: height, depth and sideways adjustable (Azalea type dartex covered) 166 ASD1427 Headrest with cheek support: height and depth adjustable (Azalea type dartex covered) 166 ASD1496 All bracketry as above option without headrest cushion 60 ASD1495 Non Invacare Headrest - no mounting hardware (with pushbar dia. 22mm in conjunction with telescopic seat frame/backposts) Neckrest 1350 Headrest 1432 Headrest (with cheek support) 1427 Lateral 1446 Lateral multi adjustable 1445 LATERAL SUPPORT ASD1446 Lateral Support (pair) (Dartex) (Azalea type) 123 ASD1445 Lateral Support with extended arm (pair) (Dartex), width and height adjustable (Azalea type) of 7

4 SEATING TYPE - MAX SEAT ASD1145 Max Seat Unit Not Available with Tray or Tray controls 4,100 SEAT WIDTH mm ASD0383 X Width of Seat Frame 550mm (21.75") (adjustable by armrests mm) SEAT CUSHION ASD1459 X Seat Cushion Max ( 550 mm x 635 mm/width x depth) BACKREST UPHOLSTERY / CUSHION ASD1104 X Tension Adjustable Upholstery(back height 560mm), with Dartex upholstery SEAT DEPTH ASD0317 X Seat depth mm (20" ") UPHOLSTERY COLOUR ASD0278 X Dartex ARMREST ASD0606 X Detachable T-armrest, adjustable in height mm, without armpads (with depth and width adjustable receiver) ARMPADS FOR T- ARMREST ASD0649 Armpad extended (375 mm) PUSH BAR ASD1307 X Push Bar SEAT ACCESSORIES for MAX SEAT HEADREST/NECKREST ASD1427 Headrest with cheek support: height and depth adjustable (Azalea type) 166 ASD1432 Headrest: height, depth and sideways adjustable (Azalea type) 166 SEAT ADJUSTMENTS for MODULITE SEAT HEIGHT Tilt Range 450mm (17.75") ASD1091 Manually settable 0-8 ASD1092 Powered basic ASD1093 ASD1094 Powered centre of gravity shift Seat riser with centre of gravity shift (300mm rise) ,028 ASD0975 ASD0977 Manually settable recline Powered Recliner with quick release for easy folding of backrest SeatRiser only available with REM24SD or G90A controls Recline Range Selection SEAT ADJUSTMENTS for MAX SEAT Tilt Range ASD1002 Manually settable 0-20 ASD1014 Electric tilt ASD0959 Manual settable recline. Not available in conjuction with seat lifter Recline Range Selection 0-30 ASD0955 Pneumatic Recliner ASD1021 Seat Lifter with electrical Tilt SeatRiser onlyavailable with REM24SD or G90A controls ,028 ASD0947 Electrical Recliner, not available in conjuction with headrest with cheek suport/neckrest and chin control of 7

5 LEGREST PAIRS/FOOTREST FOOTREST HANGER TYPE / PAIRS ASD0503 ASD0533 ASD0531 VARI F : Angle adjustable legrest hanger (swing away and detachable) (adjustable via tools 0-70 ) : knee to heel length mm VARI A : Manually angle adjustable legrest hanger (swing away and detachable) (adjustable via hand wheel / knob 0-70 ) - complete with calf pad support : knee to heel length mm ADE Powered: Electrically angle adjustable (0-80 ) legrest hanger (swing away and detachable) (powered via joystick) - complete with calf pad support : knee to heel length mm VARIF 0503 VARIA 0533 Not available with fixed footplates or angle adjustable footboard Not available with fixed footplates or angle adjustable footboard ADE FOOTPLATE TYPE / PAIRS ASD0512 Fixed Footplate pair ASD0504 Angle adjustable Footplate pair 23 ASD0513 Angle and depth adjustable Footplate pair 87 ASD0522 Angle adjustable Footboard Not available in conjunction with kerb climber 112 REMOTE ACS-SYSTEM REMOTE + BRACKET ASD1601 Standard Remote ACS REM 24SD (5 Actuator function and Lights) 147 ASD1614 G90A (5 Actuator function and Lights) 147 ASD1638 ASD1639 Standard Remote Type A (enables operation up to 4 electr. adjustments) Standard Remote Type B (enables operation up to 4 electr. Adjustments and lights) Not in combination with lights ASD1707 Swing Away + height adjust. RH high end 105 ASD1708 Swing Away + height adjust. LH high end 105 ATTENDANT REMOTE + BRACKET ASD1643 REM Type A (Up to 4 electric actuators) Not in combination with lights or 10kmp/h (6mph) 14 ASD1618 REM 550 with LCD screen 212 ASD1602 ACS REM24SD 158 ASD1616 G90A 158 CHIN CONTROL SIMPLE ASD1609 A C S Chin Remote (Only compatable with REM24SD ) Not Availble with Max seating 1,441 ASD1289 Swing Away Bracket RH, Manual ASD1288 Swing Away Bracket LH, Manual ADDITIONAL REMOTES ACS ASD1720 DUAL CONTROL (can only be selected as an addition to user remote) Compact Dual Control REM Type A REM 24SD G90 A Chin control Dual control of 7

6 PENNY&GILES REMOTE SYSTEMS REMOTE + BRACKET ASD1503 R-Net Standard Remote 165 ASD1707 Swing Away + height adjust. RH high end 105 ASD1708 Swing Away + height adjust. LH high end 105 ATTENDANT REMOTE + BRACKET ASD1504 Attendant Remote R-Net 177 ADDITIONAL PENNY&GILES REMOTES DUAL CONTROL + BRACKET ASD1595 Dual Control R-Net 102 DRIVE UNIT OPTIONS FRAME COLOUR (std. components partly in silver) ASD0228 Black ASD0203 Transparent Blue ASD0212 Electric Red ASD0233 Silver Metallic CASTORS ASD x 60mm ( 9 x 2.4") pneumatic, grey ASD x 60mm (9 x 2.4") puncture proof solid inlay, grey DRIVE WHEELS ASD x 57mm (12.5 x 2.25") pneumatic grey ASD x 57mm (12.5 x 2.25") puncture proof solid inlay grey PERFORMANCE OPTIONS SUSPENSION ASD1265 Rear suspension, strong (STRONG Silver Spring) ASD1220 Rear suspension, Xtra strong MOTORTYPE ASD km/h (4m/h) ASD1283 BATTERY 10 km/h (6m/h), includes LED light sytem with indicators and rear wheel fender ASD Ah (AGM) ASD Ah (Gel) PERFORMANCE ACCESSORIES G-TRAC G-TRACensures the powechair takes the intended direction as indicated by ASD1215 the user control, without the need for Only with Dynamic controls 605 continual correction by the client on uneven or sloping terrain. CHARGER ASD1343 X Charger 8A ( V) SAFETY OPTIONS ANTI-TIPPERS ASD1205 X Bolted on Anti Tippers LIGHTS ASD1437 LED light system with Indicators (Already included in ASD km/h motor) 255 ASD1254 Without Light system of 7

7 SAFETY ACCESSORIES KERB RIDER ASD1244 Central Kerb Rider (with parking position) 156 TRANSPORTATION KIT ASD1494 X 4-Point tie-down (Tested version for using wheelchair as a vehicle seat according to ISO :2001) ASD1495 HEADRESTS ADEQUATE FOR PERSON TRANSPORTATION Equivalent Headrest supporting the requirements of ISO :2001, provided independently from this order LAP BELT ASD1329 Lap belt with auto lock (extra long for Max Seat ) ASD2113 Lap belt with auto lock for (flexible mount in side rails, only with ModuliteNot Available with Max seating REARVIEW MIRROR ASD1415 RH 31 ASD1339 LH 31 WHEEL LOCK / PARKINGBRAKE ASD1206 X Wheel Lock / Parking Brake pair ACCESSORIES LUGGAGE RACK ASD1438 Luggage rack Not Available with 30⁰ tilt or Seat Riser 242 CANEHOLDER (in combination with attendant or dual control the caneholder has to be mounted on the opposite side of the remote) ASD1312 RH 31 ASD1363 LH 31 FENDER ASD1417 Fender for rear wheels (mandatory for 1437) 77 TRAY - mounted opposite side to controller ASD1404 Swing Away RH 122 ASD1405 Swing Away LH 122 KLICKfix BAG and BRACKETS ASD1480 HandyZip bag, removable 51 ASD1478 Quick release bracket R/H Not Available with LH control swing away ASD1479 Quick release bracket L/H Not Available with RH control swing away TOOLKIT ASD1333 Toolkit (incl.bit holder, bits and fork spanners) Special Instructions - Please let us know your preferred contact method: Total Price: Name: Fax: Description of special request (please include relevant option code or part number): 7 of 7