NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS. 3 Please refer to table on page 5 for seat size combinations. BACK SELECTION
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1 FRAME SELECTION POWER CHAIR TYPE M91-TS M91 Base w/mk6i $5,950 M71-TS M71 Base w/mk6i. $5,325 1,2 POWERED SEATING PTO-PL Power Tilt Only Plus(PTO) $2,995 Invacare Formula PTO Plus for Pronto M71 & M91 with SureStep Canadian Price List Effective March 1st, 2005 February 1st, 2007 *UPDATED - DENOTES CHANGES NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS SEAT SELECTION ADJASBA Adj. Rehab Seat w/adj. Seat Tilt & Back Angle $774 3 CTS Contoura Seating. $553 OMCU Omit Cushion...(Less Net $25) 1 MOTOR PACKAGES U275 User Wgt Under 275 lbs for PTO Plus Standard 4 U375 User Wgt Under 375 lbs for PTO $512 ADJUSTABLE SEAT WIDTH RANGE 1620W 16" to 20" Seat Width Range No Charge 2022W 20" to 22" Seat Width Rangee $429 5 SEAT WIDTH W16 16'' Seat Width No Charge W17 17'' Seat Width No Charge W18 18'' Seat Width Standard W19 19'' Seat Width No Charge W20 20'' Seat Width No Charge 4 W21 21'' Seat Width No Charge 4 W22 22'' Seat Width No Charge ADJUSTABLE SEAT DEPTH RANGE 1619D 16" to 19" Seat Depth Rangee No Charge 2022D 20" to 22" Seat Depth Rangee $355 5 SEAT DEPTH FOOTNOTES D16 Seat Depth 16'' Standard 1 Power Tilt Only (PTO) Plus is a weight-shifting tilt system that easily D17 Seat Depth 17'' No Charge interfaces to the ASBA seat frame for users with a weight limit of up to D18 Seat Depth 18'' No Charge 275 lbs. or 375 lbs. w/hd motor upgrade on M91 only. Van or Manual D19 Seat Depth 19'' No Charge Reclining Back seat styles are not available with PTO. D20 Seat Depth 20'' No Charge 2 Comes standard with single function toggle to operate tilt. 4 D21 Seat Depth 21'' No Charge For through the joystick operation you must upgrade to 4 D22 Seat Depth 22'' No Charge single actuator control (SAC). 3 Please refer to table on page 5 for seat size combinations. BACK SELECTION 4 Not available on M71 LATERALS (PAIR) 5 Contoura seating available in even widths 16" - 22" and depths CONVENTIONAL BACK between 16" - 22" in 1" increments. TCSLM Clamp On Swingaway Laterals Med. $315 TCSLMHW Removable & Adjustable Hardware No Charge TCSLL Clamp On Swingaway Laterals Large $315 TCSLLHW Removable & Adjustable Hardware No Charge For the most current pricing information visit Page 1 / 5
2 CURVED ABS BACK HEIGHT BH16 Back Height 16'' No Charge BH17 Back Height 17'' No Charge BH18 Back Height 18'' Standard BH19 Back Height 19'' No Charge BH20 Back Height 20'' No Charge 6 BH21 Back Height 21'' No Charge 6 BH22 Back Height 22'' No Charge 6 BH23 Back Height 23'' No Charge 6 BH24 Back Height 24'' No Charge CONTOURA TSBH25 Back Height 25" No Charge TSBH295 Back Height 29.5" No Charge BACK TYPE SECT Sectional Rear Uprights No Charge TILT BACK OPTION CURV Curved Back $806 POST Posts Only No Charge TILT RANGE TR of Tilt No Charge 7 TR of Tilt No Charge HEADREST TYPE (OPTIONAL) TAR Curved Headrest No Charge TAR27700HW Removable & Adjustable Hardware No Charge TAR Two-Step Headrest ) No Charge TAR128000HW Removable & Adjustable Hardware No Charge T Large Headrest $97 TAR2400HW Removable & Adjustable Hardware No Charge T Small Headrest $97 TAR22600HW Removable & Adjustable Hardware No Charge 8 ARM TYPE (PAIR) 18F Full Length Fixed Hgt. Conv. $244 19F Full Length Adj. Hgt. Conv. $348 28F Desk Length Fixed Hgt. Conv. $244 29F Desk Length Adj. Hgt. Conv. $348 MIXED ARM TYPE R28F RH Flip Up Desk Length Fixed Hgt. Conv. $122 R18F RH Flip Up Full Length Fixed Hgt. Conv. $122 R29F RH Flip Up Desk Length Adj. Hgt. Conv. $174 R19F RH Flip Up Full Length Adj. Hgt. Conv. $174 L28F LH Flip Up Desk Length Fixed Hgt. Conv. $122 L18F LH Flip Up Full Length Fixed Hgt. Conv. $122 L29F LH Flip Up Desk Length Adj. Hgt. Conv. $174 L19F LH Flip Up Full Length Adj. Hgt. Conv. $174 POSITIONING STRAP AND WHEEL OPTIONS SEAT POSITIONING STRAP 1311BK Airline Buckle Seat Pos. Strap $ Push Button Style Seat Pos. Strap Standard CHEST POSITIONING STRAP FOOTNOTES 7311BK Airline Buckle Chest Pos. Strap $79 6 Available with Curved ABS Back only Push Button Style Chest Pos. Strap $79 7 Seat-to-floor will increase based on seat depth at 5 tilt. 7321BK Hook & Loop Chest Pos. Strap ) $61 8 All arms are flip-up and detachable. For the most current pricing information visit Page 2 / 5
3 DRIVE WHEEL OPTIONS M91 DW143 14'' x 3'' Pneumatic Tires Standard DW143FF 14'' x 3'' Flat Free Inserts $184 M71 DW /2'' x 3 1/2'' Pneumatic Tires Standard DW10535FF 10 1/2'' x 3 1/2'' Flat Free Inserts $161 SHROUD COLORS BL Deep Blue Pearl No Charge RD Candy Red Pearl No Charge MB Magic Black No Charge ACCESSORIES ARM ACCESSORIES L8401 Omit Arms.... Less net ($25) L8405 Omit Arm Pads. Less net ($15) MISCELLANEOUS ACCESSORIES 1209 Tire Pump $59 LESTR Lester 8 Amp Battery Charger $332 BATTERY SELECTION 9 BATTERIES M NFBATTERY 22 NF Battery (On Chair) $ NFMKG-2 MK Battery Gel - 2 Each (Off Chair) $534 M71 10 U1BATTERY U1 Battery (On Chair) $ U1BH-2 U1 Battery (Qty 2) with handle (Off Chair) $484 MK6i ELECTRONICS MK6i CONTROLLERS - M91-TS 12 MK690ACC 90amp Controller w/actuator Control.. Standard MK6i CONTROLLERS - M71-TS MK660ACC 60amp Controller w/actuator Control.. Standard STANDARD DRIVER CONTROL SPJAP SPJ+ w/power Seating Switch. Standard TILT OPERATION THROUGH SPJ 13 SPJAPM SPJ+ w/through Joystick Actuator Option $1,535 ALTERNATIVE PROPORTIONAL CONTROL OPTIONS MPJM6U MPJ+ Multiple Joystick Drive Joystick $ PSFM6 Personal Joystick, Inductive on Front. $ PSRM6 Personal Joystick, Inductive on Rear. $ PBOD Push Button. On/Off w/pb Drive Select $84 FOOTNOTES 15,16 PBSS Push Button. On/Off w/speed Select $84 9 Contact Customer Service for net pricing. 16 OR On/Off Right No Charge 10 A pair of batteries installed and chair shipped complete. 16 OL On/Off Left No Charge 11 A pair of batteries shipped separately and not installed. 17 ASLRDYM6 MK6 Display Only (No Driver Control)... No Charge 12 Required for Heavy Duty Option, M91 Only. FOR ALL YOUR ASL DRIVE SYSTEM NEEDS PLEASE REFER TO THE FOLLOWING ASL PRICE LIST FORM C 13 Allows Actuator Operation through Driver Control. 14 TOD-SS: Toggle On/Off Drive Select, Speed, Speed Potentiometer Standard 15 Drive Select through mode switch, or mode switch and Joystick Commands 1500M6 Proportional RIM Head Control $2, PSRM6 Only. SMHD Small Headrest $ Display Only, No Driver Control. Allows choice either from Price Sheet. LGHD Large Headrest $ Must also use either a Multiple Drive Joystick or MK6 Display. 1558MM6 Compact Joystick w/ Display $1, Requires SNPM6 Sip-N-Puff Interface Box. For the most current pricing information visit Page 3 / 5
4 ALTERNATIVE DIGITAL CONTROL SYSTEMS 18 SNPM6 Sip-N-Puff $1, M6 Wafer Board w/snp/di $2, M6 Mini Tash Joystick & Digital Interface Box $2,506 SIP N PUFF KIT PKG32666 Therapin Sip-N-Puff Breath Tube Kit $411 ADDITIONAL CONTROL CHOICES 1558M6 Compact Joystick - Less Std Mount $ Wafer Board $ Mini Joystick w/push $513 PACM6 Proportional Attendant Control $ M Attendant Control $529 JOYSTICK MOUNTING HARDWARE 20 QLAM6 Quad Link Retract Joystick Mnt MPJ+ $334 LEFT Left Hand Mounted Joystick No Charge RIMHW Rim Hardware For $229 PKG32669 Complete Bib Assembly (Tash/1558)... $379 RCM Rear Cane Mount for Compact Joystick... $ QLA Quad Link Retract. Joystick Mnt SPJ+ $334 CGAT I Gatlin Midline Mount Horizontal - Invacare MK6i for MPJM6 $914 CGAT D Gatlin Midline Mount Horizontal - Invacare for DPJ/SPJ & SPJPLUS $914 CGAT400V-427I Gatlin Midline Mount Vertical (chin mount) - Invacare MMK6i for MPJM6 $914 CGAT400V-426D Gat.Mid. Mnt Vertical (chin mount) - Invacare for DPJ/SPJ & SPJPLUS $914 CGAT R Gatlin Midline Mount Horizontal - Invacare 1812 $914 CGAT400V-480R Gatlin Midline MountVertical (chin mount) - Invacare 1812 $914 ELECTRONIC ACCESSORIES 1813M6 MK6i Programmer w/pro Memory Card $ SD Pro Memory Card $ T Handle Flexible Joystick Extension... $ Straight Handle Flexible Joystick Extension $64 MPJLHS MPJ+ Lateral Support Platform, Left... $58 MPJRHS MPJ+ Lateral Support Platform, Right... $ Chin Cup $36 A24VPS 24V MK6i Auxiliary Power Source... $235 AUX12M6 Auxillary Module For 1 & 2 $659 AUX34M6 Auxillary Module For 3 & 4... $ MPY Mono Port Y Cable... $20 POWER SEATING ACCESSORIES 22 SANODE Single Actuator Operation through Driver Control. $994 *UPDATED - 02/01/ PRICING UPDATED FRONT RIGGING OPTIONS FOOTREST/LEGREST (PAIR) PHW93 Swingaway Footrests 13 1/2" - 19" $163 PH904A Swingaway ELR 16" /4" $ PHAL4A Smartleg Art. Legrests 17 1/4"-21 1/2" ) $366 CTMT-F Center Mount Adjustable Knee Angle $262 FOOTNOTES 20 QLA includes ARM250 FOOTPLATE OPTIONS 21 For use with MPJ+ or MK6i Display to provide additional switch site Extra Large Aluminum Footplates $99 22 Required for Tilt Operation through Driver Control - Multiple Drive 1450 Aluminum Footplates Deluxe $71 System only (not SPJ+) Aluminum Footplates No Charge 23 Allows 60 to 90 static knee angle positioning with a drop back lever for 1651 Flip Up Composite Footplates No Charge easier transferring. Available in short (12.5" ") and long extension AT5543 Adjustable Angle Flip Up Footplates $122 (17.25" ") ranges. AT5543O AT5543O Footplates Not Selected... No Charge 24 Not available on 16" wide frame. For the most current pricing information visit Page 4 / 5
5 FOOTREST/LEGREST ACCESSORIES LPT2 Longer Pivot Slide Tube For 1350 $123 A1337 Calf Strap $59 IMPACTG Impact Guards No Charge ALPT Longer Pivot And Slide Tube $123 ALPT4 Longer Pivot And Slide Tube 4" $123 SEATING AND POSITIONING Invacare Canada reserves the right to change prices and specifications without notice. HEAD OFFICE Matheson Blvd, Unit# 8, Mississauga, ON L4G 4Z4 Phone: (905) (800) (Canada) Fax: (905) (800) (Canada) Regional Centre Boul. Hymus, Kirkland, P.Q. H9H 3L4 Phones: (514) (800) (P.Q.) Fax: (514) DISTRIBUTION CENTRE - # Cliveden Avenue, Delta, BC V3M 6M2 Phone:(800) (Canada) Fax: (888) (BC & AB) Invacare, and Yes, you can., are trademarks of Invacare Corporation. For the most current pricing information visit Page 5 / 5
NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS. 4 Package includes 4 pole motors and 6.5 MPH top speed unless TRUTK CONVENTIONAL
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Phone 0800 5 Fax 0800 5 365 Funder: Account Number: Date: Quote PO Number: Therapist: Marked For: Focus CR $ 36kg weight capacity. Tilt range: -5º anterior to 50º posterior. Effective /0/0 Ship To: Address:
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JIVE F/R: 5,650 9,193 JIVE M: 5,895 9,591
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Page 1 of 13 INTRODUCTION PATIENT INFORMATION
Pride Mobility Products Co. For AADL use only 5096 South Service Rd, Beamsville, ON, L0R 1B3 Phone: 888-570-1113 Fax: 866-514-1303 Email: productorders@pridemobility.com Q6 Edge HD Order Form with TRU-Balance