Zippie GS SE January 2019 EIZGS

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Everett Marshall
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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: ( )

1 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: Ship T City: ST: Cnfirm Via: Fax Ship T Phne: ( ) Fax: ( ) ZIP: Mark Fr: The HCPCS CODES prvided are based n cde verificatin thrugh PDAC r ur interpretatin f the cde definitins. The use f HCPCS CODES des nt ensure cverage r payment. Fr cverage infrmatin, verify the apprpriate payer's cverage plicy. a Optin # HCPCS Definitin Price a Optin # HCPCS Definitin. FRAME All Zippie GS mdels grw in width and depth. Price 087WM74 E238 Flding Grwing Zippie GS Transit Optinal True Fit Grwth nt included $2, WM75 E237 Rigid Grwing Zippie GS Transit Optinal True Fit Grwth nt included $2,000 Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 5"-8" widths = K0005 Frame Optins 087FC5 Reverse Cnfiguratin ( w/ Swing-Away hangers nn-rem. in reverse cnfig.; lift ff hangers recmmended.) 087FC3 Standard Cnfiguratin 2. TRANSIT SYSTEM ( Fr use when Transit ptinal is chsen abve) Tie Dwn Requires: Slid Seat and Slid Back r, Grwing Seat Pan and JAY Fit r Cnventinal Back r, Grwing Seat Pan and Slid Back r, JAY Fit and/r Cnventinal Seat & Back 087TO9 Transit Optinal. Seating (Req. Selectin f Seat & Back) $ TO3 087TO5 Transit Optinal w/ Seating $250 Transit Omit 2. SIZE/SEATING Frame Width Frame Depth and Back Pst Lcatin Height Adjustable Arms with 0"-3" Frame Widths 087FL3 Shrt Frame 087BW4 Small Crss Brace 0" " 2" 3" 4" 0" " 2" 087FL9 Regular Frame 087BW5 Medium Crss Brace 2" 3" 4" 5" 6" 2" 3" 4" 087FL8 Lng Frame 087BW6 Large Crss Brace 4" 5" 6" 7" 8" 4" 5" 6" 087FL94 X-Lng Frame 087BW7 X-Large Crss Brace 6" 7" 8" 9" 20" (20" use HCPCS: E2203) 6" 7" 8" Custmer Service: Fax: rders@sunmed.cm Web: Page

2 2. SIZE/SEATING CONT. 087ST55 087PN3 087ST27 E223 Seats Slid Seat (Req. Slid Back) ( w/ 0-, 9-20 inch frame depth r 7-8 inch frame width.) JAY Cushins (Optinal) $200 T rder any JAY cushins n-chair, please see the JAY price list. Cushin name r part number must be filled ut with desired width and depth. 087JC20 E223 Grwing Seat Pan Depth (Fig. ) Omit Seat JAY Bundled Cushin Name / Part # Width: Depth: $200 Price List REFEREE ONLY Seat Depth Pan Size Depth Range Minimum Maximum Shrt 0-2" 0" 4" Medium 3"-4" 3/4" 6 /4" Lng 5"-7" 3 3/4" 8 /4" X-Lng 8"-20" 5 3/4" 20 /4" Depth Figure 7. - Frame Depth Grwth Range Matrix 087CW30 087CW3 087CW5 087CW5 087CW7 087CW33 087CW34 087CW35 E229 6" x.5" Semi-Pneumatic 087CW2 087CW32 087CW39 087CW36 087CW37 Caster Wheel Caster Optins 3" Micr Light Up $65 087CS5 3/4" Lnger Frk Stem Blt 4" Micr Light Up $70 087CS9 /2" Lnger Frk Stem Blt 5" Micr Light Up Caster Pin Lcks 087CS3 K0073 5" Lw-Prfile Plyurethane ( with 8" x 2" casters r Transit Opt.) $95 E229 5" x.5" Semi-Pneumatic 087CW38 Omit Caster, Wheels & Tires E225 E225 E229 E225 6" Pneumatic 6" Plyurethane 8" Pneumatic 8" Plyurethane 8" x.5" Semi-Pneumatic 8" x 2" Pneumatic 8" x 2" Pneumatic w/airless Insert 3. CASTERS/SEAT HEIGHT $45 $ REAR WHEELS/SEAT HEIGHT Axle Plate Axle 087AL7 E0958 One Arm Drive (Avail w/ 20",22",24" Mag Rear Wheels & 3"-8" wide) $ AX26 One Arm Drive Axle (Only avail. w/one Arm Drive Optin) 087OA2 087HM 087HM2 087OA 087HM 087HM2 Standard Handrim Right Left Small Handrim Right Left 087AX 087AX Quick Release Quad Quick Release ( with Lite Spkes) $25 Custmer Service: Fax: rders@sunmed.cm Web: Page 2

3 4. REAR WHEELS/SEAT HEIGHT CONT. 087RW48 087RW4 Rear Wheel Size 2" Mag ( with handrims) 6" Mag ( with handrims) 087RW3 20" Mag 087RW8 22" Mag 087RW 24" Mag 087RW2 8" Spke 087RW74 20" Lite Spke 087RW75 22" Lite Spke 087RW54 24" Lite Spke $ RW25 Omit Rear Wheel & Axle - 087HR 087HR4 087HR7 087HR8 Aluminum Andized Plastic Cated Omit ( with wheel/axle credit) 8 Oblique Handrim Prjectins ( n Plastic Cated) *Only available with 24" wheels & with spke guards. $325 Rear Wheel Tire 087RT Pneumatic 087RT2 087RT3 E22 E223 Pneumatic Airless Insert Full Plyurethane ( w/ 2", 6" and 8" rear wheels) 087RT4 Lw Plyurethane (Only available with 2" and 24" wheels ) 087RT6 E22 E222 High Pressure Clincher (Avail. w/ 24" spke wheels, with mag wheels) $95 5. WHEEL LOCK/HUB LOCK 087WL 087WL2 Wheel Lck with Hub Lcks High Munt Push High Munt Pull Hub Lck *Only available with 2" r 6" wheels. with One Arm Drive. 087LK0 2" Hub Lck 087LK02 6" Hub Lck 087WL25 087WL0 Ft Lck (may limit flding width, in rev. cnfig.) Omit 087WL2 D Nt Munt 087EH E096 Extensin Handle 6" Pair Custmer Service: Fax: rders@sunmed.cm Web: Page 3

4 087H4 087E 087E2 087E5 087E6 087F4 E0990 Elevating ( w/ cmpsite r platfrm ftplates r < 6" width) Extensins Shrt (.5" - 4") Med (4" - 7") ( w/ ELR) Lng (7" - 9") High Munt Ftplate Kids Angle Adjustable ( w/7"-8" width) Aluminum (Only available with elevating leg rests 4"-8") Platfrm Flip-Up (Avail n and 80 ext. munt hangers nly) 6. HANGER and FOOTRESTS Aluminum Angle Adjustable 087F3 $85 Hanger Munted Ftrest (Ftplates Munt t Hanger Tubing) Hanger Type 087H89 70 Swing In/Out Frnt Munt 087H90 80 Swing In/Out Frnt Munt 087H6 90 Swing Away Frnt Munt 087H9 70 HD Frnt Munt Lift-Off 087H0 80 HD Frnt Munt Lift-Off 087H 90 HD Frnt Munt Lift-Off 087H23 E Elevating ( 0"-" wide) $295 Extensins (may interfere with sme seat heights & casters) 087E23 2" (nt munted) 087E24 4" (nt munted) Ftplate Kids Angle Adjustable 087F9 $85 ( w/7"-8" widths) 087F8 087H85 087H86 087H6 Adult Angle Adj. (Available with 0"-8" widths) Hanger Type 60 Swing In/Out 70 Swing In/Out 80 Swing In/Out ( with 6" r 8" Casters) 087H24 K0053 Articulating ( w/cmpsite ftplates r 0"-3") 087F62 087F 087F5 087F48 Ftbard (Available with 0"-6" widths) Ext. Tube Munted Ftrest (Ftplate Munt t Ext. Tube) Cmpsite ( In 0", " r 2" width) $85 $90 $370 $295 $85 $90 Rear Wheel Size 2" 2" Lw Ply 6" 8" 20" 22" 24" Frnt Seat t Flr Height Guide (Reference Only) 3" 4" 5" CASTER SIZE 6" 8"X.5" 20.0" 20.0" 8"X" 20.0" 20.0" Based n.5" seat angle. T achieve desired seat height see matrices n last page. Custmer Service: Fax: rders@sunmed.cm Web: Page 4

5 6. FOOTRESTS CONT. 087IG2 087HL 087A0 Ftrest Hanger Optins 087HL5 K0038 Leg Strap $40 Neprene Cvers (Avail. n 60 / 70 / 087A54 K0038 Extra Single Leg Strap $30 $90 80 ext. munt hangers nly) 087H33 Omit Hanger -$5 E095 Heel Lps $40 087F7 Omit Ftplate & Ext. Tube -$5 Te Lp (Only avail. w/ adult angle 087HL4 Omit Heel Lp E0952 $40 adjust. ftplates) 087HL6 Omit Single Leg Strap 7. BACKREST/SEATING Back Height JAY Backs (Optinal) (Slid Back Depth = 2" Less Than Frame Depth) Ordering JAY backs n-chair, See the JAY Price List. Requires Part # 087B240 Shrt Slid Back 2" JAY Bundled Backrest 087B24 Med. Slid Back 4" 087JB02 Backrest Name r Part # Price List 087B242 Tall Slid Back 6" Width: Height: 087BU4 Omit Backrest Back Psts 087BP9 087BP0 087BP 087BP3 087RG Fixed Height Lw (9" Ht) Medium (22" Ht) Tall (25" Ht) Remvable Extensin Flding Adjustable Rigidizer $75 087B PH8 087PH9 087B PH8 Height Adjustable Rigid Frame w/ Angle Adjust Push Handle. (6"-22" Height.). Angle Adj. Push Handle Lng Angle Adj. Push Handle Tall (9"-25" Height.). Angle Adj. Push Handle 087PH9 Lng Angle Adj. Push Handle Flding Frame with Push Handle 087B BP47. (7"-23" Height.) Swing Away Handle ( with dual triggers) 087B205 Tall (20"-26" Height.) Fixed Rigid HANDLE HEIGHT DIAGRAMS Flding 087BP47 Swing Away Handle ( with dual triggers) 8. ARMRESTS 087SG33 087SG29 087AA2 087AA3 087AA3 087AA 087AA7 087AM23 087AM24 087AM9 087AM0 Side Guard Armrest and Armpad - Height Adjustable ( with height adjustable armrests r T-Pst) 087AA E0973 Single-Pst Height Adj.. $285 Plastic $40 087AM23 Desk Classic Plastic Lw $40 087AM2 Desk Cntur 087AM24 Full Classic Armrest and Armpad 087AM22 Full Cntur E0973 T-Pst Regular w/fam $ AA29 E0973 Single-Pst Height Adj. Lw $285 E0973 T-Pst Tall w/fam $ AM23 Desk Classic Flip-Up 087AM2 Desk Cntur E0973 Adjustable Lcking Flip-Up $ AM24 Full Classic E0973 Length Adjust. Lcking Flip-Up $ AM22 Full Cntur Desk Classic (0") ( w/t Pst) Full Classic (4") ( w/t Pst) Armrest Receiver fr Height Adjustable Armrest Fam Shrt ( w/t Pst) 087AR7 Lw Fam Lng ( w/t Pst) 087AR8 Custmer Service: Fax: rders@sunmed.cm Web: Page 5

9. KEY OPTIONS 087AO2 087AT7 087A2 E0978 " Dual Pull Side Squeeze Padded 087A7 E0978 Belt 2" Aircraft Buckle 087A8 E0978 Belt 2" Aircraft Buckle Padded 087A4 E0978 Belt.

chair width) Small (Suggested 3"-4" chair width) Medium (Suggested 5"-7" chair width) Large (Suggested 8"-20" chair width) Standard Clrs $50 Rear Anti-Tip $40 Upper Extremity Supprt Tray $0 $20 $70

6 9. KEY OPTIONS 087AO2 087AT7 087A2 E0978 " Dual Pull Side Squeeze Padded 087A7 E0978 Belt 2" Aircraft Buckle 087A8 E0978 Belt 2" Aircraft Buckle Padded 087A4 E0978 Belt.5" Aut Buckle 087A84 E0978 " Cmfrt Fit APB56 087A29 087A30 087A3 087A32 E097 E097 Anti-Tip Frnt Anti-Tip ( with caster pin lcks r transit ptin) Psitining Belt (w/clamps) X-Small (Suggested 0"-2" chair width) Small (Suggested 3"-4" chair width) Medium (Suggested 5"-7" chair width) Large (Suggested 8"-20" chair width) Standard Clrs $50 Rear Anti-Tip $40 Upper Extremity Supprt Tray $0 $20 $70 $20 087C40 Aztec Gld 087C2 Black ( as base w/zebra) 087C4 Black Cherry 087C0 Black Opal 087C38 Blue Opal 087C36 Candy Blue 087C4 Candy Purple 087C35 Candy Red 087C42 Electric Blue 087C43 087C26 Evergreen Glw 087C44 Green Apple 087C47 Ht Sparkle Pink 087C48 Mauve Pink 087C03 Rtbeer 087C4 Sparkle Silver 087C45 Sunrise Orange 087C3 Titanium Clr Paint 087C8 Yellw 0. COLOR (Need 2" back pst clearance t munt canpy hardware, may require next height based n seating; please nte sme interference may ccur with sme headrest cnfiguratins) ( with 2", 6" and 8" rear wheels & Prjectins Handrims) 087A23 K0065 Black 087A303 K0065 Clear Zippie 0878A A07 087A 087A2 087A83 087A8 087C6 087C5 087C52 087C50 087C49 087C43 087C42 087C08 Cmmnly Requested Optins Include: Dynamic Back Reclining Backrest Custm Andizing Custm Paint O2 Hlder with Transit IV Ple with Transit Canpy (SunShade) Canpy (Sunshade) 0"-4" Width Canpy (Sunshade) 5"-20" Width Back Pack (Kids Backpack included) Utility Backpack - Black Additinal Kids Black Backpack $60 Tl Kit Spke Guard Miscellaneus Black Seat Puch Standard Matte Clrs Matte Black Matte Black Cherry Matte Purple Matte Electric Blue Matte Evergreen Custm Clrs Mssy Oak Camuflage $5 $275 $275 $45 $50 $395 Stars and Stripes $395 Zebra (Chse base clr abve: White, black) Additinal Optins Thrugh Built-4-Me $5 $395 T inquire abut any unique custmizatin fr Zippie prducts, cntact: Phne: (800) , Fax: (800) Custmer Service: Fax: rders@sunmed.cm Web: Page 6

7 Caster Frk Size 5-/4" ( with 6" ( with 7" ( with 8" Wide (Must use with Caster Stem Zippie GS Seat Height Setup Caster Caster Size Frk Hle 3" 4" 5" 6" 8"x" 8"x.5" Psitin " " 20.0" Sunrise Medical (US) LLC 2842 Business Park Ave. Fresn, CA USA Custmer Service: Fax: rders@sunmed.cm Web: Page 7

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: