Invacare A4 Ultralight Active Performance Rigid
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1 Invacare A4 Ultralight Active Performance Rigid Price List and Order Form Effective January 15, 2008 Revised September 22, 2009 For ease of ordering, contact customer Service Toll Free at: Fax: To order Literature: Company Name Account # Phone P.O. # Date Ship to Name & Address 3gSpecial 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 TA4 Aluminum Adjustable Rigid Frame (K0005)...2, FRAME MODIFICATIONS TFE Tapered Front End... No Charge VFE V Front End... No Charge 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 (E2203) D22 22" Deep (E2204) 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 lbs)... No Charge SET300 Firm Setting (Max. User Weight 300 lbs)...standard 5 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 X = Sizes available. S = Available through specials only. Adjustable Rigid Frame 1 V front end provides 1" larger footplate than Tapered Front End. 2 Not available on Tapered Front End. 3 Only available with W20, W21, W22 seat widths. 4 LSS Front and Rear Suspension was developed by Invacare and Frog Legs Inc and are manufactured by Frog Legs. 5 Firm setting recommended for active users lbs. Must select SOFR for suspension setting.
2 SEAT-TO-FLOOR HEIGHT FRONT SEAT-TO-FLOOR FSTF17 Front STF Height 17" (18" with SOFR)... No Charge 6 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 SETTING 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 R " (17.5" with SOFR option)... No Charge R17 17" (18" with SOFR option)... No Charge R " (18.5" with SOFR option)... No Charge R18 18" (19" with SOFR option)... No Charge R " (19.5" with SOFR option)... No Charge R19 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 7 Rear Wheels 22" 24"* 26" 17 FSTF 14.5" 16" 15.5" 17" N/A 18 FSTF 14.5" 17" 15.5" 17" 16.5" 18" 19 FSTF 14.5" 18" 15.5" 18" 16.5" 18" 20 FSTF 14.5" 19" 15.5" 19" 16.5" 19" 21 FSTF N/A 15.5" 20" 16.5" 20" *For 25" Spingery Spox wheels, use 24" rear seat-to-floor. 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/FOLD DOWN FLDWN Fold-Down Back...No Charge BACK TYPE 9 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 CASTERS & 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 10,11 6PNEU 6" X 1.25" Composite Pneumatic Casters ,11 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 6 17" FSTF not available with 6" casters. 7 SOFR selection raises RSTF range by 1". 8 Rigid side guards included with the T-Arms. 9 ¾" tube telescoping in 1" tube. 10 Not available with 22" wheels or FLOSF. 11 Only available with "V" front end. For the most current pricing information go to page 2
3 WHEEL OPTIONS (PAIR) 22COM 22" Composite Wheels... No Charge 12 24COM7 24" Composite 7 Spoke Wheels... No Charge 13 22SP 22" Spoke Wheels... No Charge SP 24" Spoke Wheels... No Charge 15,16 26SP 26" Spoke Wheels ,16 559TS 559 Turbot Spoke SPIN24 24" Spinergy Spox Wheels SPIN25 25" Spinergy Spox Wheels SPIN26 26" Spinergy Spox Wheels SPLX24 24" Spinergy LX Wheels SPLX25 25" Spinergy LX Wheels FN Sun Fusion 16 Spoke Wheel FN Sun Fusion 16 Spoke Wheel FN Sun Fusion 16 Spoke Wheel HPS 24" High Performance Spoke Wheels HPS 26" High Performance Spoke Wheels ,19 3SCF 559 Three Spoke Composite Wheels KNOB 24" Spoke Wheels w/knobby Tires... No Charge 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 PNEUFF Flat Free Inserts (E2213) URETH Urethane (treaded) Tires... No Charge PRIMO Primo Tires KIKB KIK Black Tires CRF123 Schwalbe 1 Blk. Flat Resistant Non Marking HANDRIM OPTIONS (PAIR) ALUMPC Aluminum Anodized Handrims...Standard 22 A1512K Black Plastic Coated Handrims AT Plastic Coated w/8 Oblique Projections ,25 AT Plastic Coated w/8 Vertical Projections ,25 AT Plastic Coated w/12 Vertical Projections ,27 NFITSD Natural Fit Handrims Standard Grip NFITSP Natural Fit Handrims Super Grip NFSDLT Natural Fit LT Handrims Standard Grip NFSPLT Natural Fit LT Handrims Super Grip Available with PNEU, PNEUFF and URETH tires. 13 Available with PNEU, PNEUFF, URETH and KIKB tires. 14 Available with PNEU or PNEUFF tires. 15 Available with PNEU, PNEUFF, PRIMO and KIKB tires. 16 Spoke wheels come standard with dome, quick release button axle. 17 Available with PNEU or PRIMO tires. 18 Available with PRIMO, CRF123 (except 3SCF) tires. 19 Considered a 24" diameter wheel. 20 FN1624 available with PNEU, PRIMO, KIKB, CRF123; FN1625 available with PRIMO, KIKB,CRF123; FN1626 available with PNEU, PRIMO, CRF123. Omit Rear Wheel option selected-chair will be built for 24 wheels 21 The Schwalbe tire is a black high pressure pneumatic tire that is non-marking and includes a Smart Guard puncture resistant layer. Schwalbe tire is only available with 24SP,26SP,24HPS,26HP,SPIN24,SPIN25,SPIN Not available with 3SCF wheels. 23 Not available with 3SCF, SPIN24, SPIN25, SPIN26 wheels. 24 Available with 24COM7, 24SP, 24HPS wheels. 25 Not available with 24KNOB wheels. 26 Not available with 22SP, 3SCF, SPIN24, SPIN25, SPIN26, and KNOBT tires. 27 Available with 24COM7. 28 Not available with 22COM, 22SP, 3SCF, 24KNOB, 559TS wheels. MOUNTING HANDRIMS IN Mount Inside Handrim...No Charge 29 OUT Mount Outside Handrim... Standard WHEEL LOCKS (PAIR) A1598 Hill Holder Clamp-On Wheel Locks (E0974) Push To Lock Wheel Locks...No Charge 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 INSERTS 31 (MUST CHOOSE 2 W/ DUAL CAMBER) 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 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 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) Decreases overall width by.75". 30 Not available with T-Arms. 31 Factory set to lower camber angle. For the most current pricing information go to page 3
4 FRAME FINISH COLORS CONTEMPORARY COLORS 24P Wet Black... No Charge 71P Silver Vein... No Charge 60P Silver Metallic... No Charge 115P Black Prism... 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 STRAPS SEAT POSITIONING STRAP 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 L8651 Omit Seat Upholstery... Less SP-01 Seat Pouch 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 /4" 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 Down Side Guards (K0108) FRONT RIGGING OPTIONS FOOTPLATE OPTIONS AT5041 Adjustable Angle One Piece Footboard (K0040) RGDTUB 1 Piece Tubular Footplate...No Charge 37 FOOTREST/LEGREST ACCESSORIES (PAIR) FRMPPRBK ChairArmor Black Neoprene Frame Protectors FRMPRB ChairArmor Blue Neoprene Frame Protectors FRMPRS ChairArmor Silver Neoprene Frame Protectors FRMPRR ChairArmor Red Neoprene Frame Protectors BASROLLER Basketball Roller CALFSTRAP Calf Strap (K0038) SEATING SEATING CUSHION SELECTION 38 SD Single Density Cushion (E2601/E602) 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) Touch Up Paint not available in all colors. 33 Not available with AT99 arms. 34 Not available with SPIN24,SPIN25,SPIN Used for attaching accessories to wheelchair. Attaches ¾" tube to 1" tube. 36 Not available with AT99 Arms. 37 Only available with tapered front end. 38 For additional information (size availability, additional seating options and pricing) see form # Rehab Seating and Positioning Products price list. For the most current pricing information go to page 4
5 FOR ADDITIONAL 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, knowledgeable of the particular limitations of the product. Basic Chair Includes: Aluminum Adjustable Rigid Frame Tapered or "V" Front End Seat Widths (W12-W19) Seat Depth (D14-D19) 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) URETH Urethane (treaded) 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 RGDTUB 1 Piece Tubular Footplate IMPACTG Impact Guards 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 Adj. Category) Adjustable Angle Back -15, -10, -5, 0, 5 Camber Angles 0, 3, 6, 9, 12 Tubing Sizes: 1" Aluminum Weight Limit 300 lbs. Weight of Chair 14.5 lbs. (15 x 16 without rear wheels and accessories) Warranty Lifetime on frame Available Through Our Specials Department 3" Depth Adjustable Frame SM (Longer Frame w/back Canes Set Forward) Caster Swivel Locks SM Flip Up Footplates C Flip Up Footplates V Front End SM One Arm Drive 0 Degree Camber SM Swingaway Front End SM Amputee Attachment SM (Longer Frame w/back Canes Set Forward) 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 FSTF21 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 Frog Legs, Inc. Specifications and prices are subject to change without notification Invacare Corporation Form No Rev 0909
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.6 APEX ORDER FORM - International P.O. number:*
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2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.6 VELOCE ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 Helio A7 ORDER FORM - INTERNATIONAL P.O.
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2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 VELOCE ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio A6 ORDER FORM - INTERNATIONAL P.O.
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 P.O. number:* Date: Ship to:* Company Name:*
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4.7 160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com Helio C2 ORDER FORM - INTERNATIONAL P.O.
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio A6 ORDER FORM - CANADA P.O. number:*
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 orders@motioncomposites.com www.motioncomposites.com 4.8 MOVE ORDER FORM - INTERNATIONAL P.O.
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.6 P.O. number:* Date: Ship to:* Company Name:*
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