SPEEDY 4all "Classicline"
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- Augustus Mills
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1 Im Hofstätt 11 D Dotternhausen Tel +49 (0) Fax +49 (0) Quotation date: Order date: according to GTC PRO ACTIV GmbH SPEEDY 4all "Classicline" Active easy running rigid frame wheelchair Approved up to 120 kg user load capacity , Medical suppliers / Company address: Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact: Invoice address: same as company address Rechnungsadresse: other (see below) Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact: Shipping address: same as company address other (see below) Name: Street: Postcode, city: Customer name / commission: Name: Street: Postcode, city: Phone.: Fax: Date of birth: Paying organisation: Indication: / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
2 Basic size Body size: Body size: Weight: cm kg Lower leg length: cm (anatomic dimension: hollow of the knee to the foot sole) Wheel chair dimensions: Seat width SB Seat depth ST Back height RH Lower leg length USL Seat height back SHh The following dimensions are optionally available subject to surcharge: Short frame Long frame The following dimensions are optionally available subject to surcharge: Seat height front SHv Tipping point KP Please cross on the appropriate dimension (all dimensions are specified in cm). Underlined values are standard settings. The values SHh and SHv may deviate from the specified values depending on the wheel size and wheel camber! Special dimensions possible upon request / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
3 Frame colour - One-colour design Information on current colour designs and example images under: White RAL 9016 gloss matt Brilliant Silver gloss Anthrazit RAL 7016 gloss matt Black RAL 9005 gloss matt Deep black, silver effect gloss Pure orange RAL 2004 gloss Fire Red gloss matt Pink magenta RAL 4010 gloss matt Sky blue gloss Pastel blue RAL 5024 gloss matt Navy blue gloss matt Apple green gloss matt Lemon green gloss matt Purple gloss Yellow RAL 1023 gloss matt Red RAL 3001 gloss matt Colour - Attachment parts Drive wheel Aluminium rim and hub Caster fork and bearing block silver Rahmenfarbe Frame colour - - Einfarbdesign Two-colour design Information on current colour designs and example images under: Note: With two-colour design, according to both colours of the gloss level of the design colour. Two-colour design comprising one basic colour (on the back of the frame) and one design colour (on the front of the frame) Please select from the following colours: Base colours (on the back frame): White Silver Anthracite Black Pastel blue Lemon green Yellow Design colours (on the front frame) Yellow gloss matt Lemon green gloss matt Blue gloss matt Chili gloss matt Pure orange gloss matt Cappuccino gloss matt Black black If no details have been made, the attachment parts are mounted in black. Attachment parts colour design according to customer desires: Drive wheel 1 Aluminium rim and hub Orange RAL white RAL in frame colour Selection from single colour design deviating from the frame colour " Aluminium rim 2 3 spoke design Please enter the last 3 digits of the desired colour (single colour design): gloss matt Special colour requests (frame or attachment parts) Frame colour single procurement Frame from RAL range of colours Surface coating: gloss matt / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected Colours Rev Colour details with RAL number Note: Attachment parts not possible in design colours 1 Only in combination with aluminium rim drive wheel Only in combination with caster wheel 5" Aluminium rim 3-spoke design smooth running or 5" Aluminium rim 3-spoke design good shock absorption
4 Frames Note: Footrest area with V-shape x=sb (0,25 x USL + 6cm) Straight Front end Knee angle 105 Straight Front end Knee angle 95 Min. 4 cm seat slope and max. caster wheel size 5" Front end V-shape Knee angle 95 from SB 33 cm Front end V-shape Knee angle 105 from SB 33 cm Custom-made seat width dimension cm with frame reinforcement dimensioned for 120 kg user load capacity Push handles Back tube with integrated handles straight tubes, also possible with lordosis bend: 1cm 2cm 3cm Aluminium push handles fixed in back tube from RH 23 cm Safety push handles with continuous height adjustment Mount in the back tube from RH 30 cm with belt cover from RH 43 cm with back shell Safety push handles backpositioned length 45 cm continuous height adjustment, Safety push handle holder mounted on the back cross bar Up to a SB of 42 cm or a body weight of 95 kg, not in combination with the armrest Push handles, horizontally screwed in back tube can be unscrewed Backrest Folding backrest way inclination adjustment with integrated plastic coated aluminium side parts Back tubes with lordosis bend cm 2cm 3cm Back equipment Adaptable back with back padding Colour: black Equipment with back cross bar Raised back cm (for the nominal back height dimension) Only in combination with continuous height adjustable push handles Art no ! Equipment without back upholstery and back padding or back system Equipment with back cross bar Further back systems e.g. ergonomic back shell see separate dimension sheet: "PRO ACTIV seat and back systems" Seat upholstery Body Contour Open belt system / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
5 Equipment without seat upholstery Seat cushion Armrests 25 cm long arm padding mounted on the clothing guard Upper arm padding edge depending on the clothing guard setting mounted approx. 20 cm to 24 cm above the seat tube. Only in combination with clothing guard! rectangluar contour radius contour Armrests fold up, removable with arm padding 25 cm long Positioning: upper arm padding edge approx. 25 to 31 cm above the seat tube, adjustable in 1.5 cm steps Not possible in combination with safety push handles back-positioned, Art. no.: ! Axle plate Standard equipment with 12 mm sockets / axles, further axle plates on request. Standard axle plate cover: black, breathable, open fabric surface black, closed fabric surface If no specification is given, the cover material "black breathable, open surface" will be delivered. Further seat cushions, e.g., "Anti-Decubitus" see separate dimension sheet: "PRO ACTIV "Seat and back systems" Clothing guard Aluminium clothing guard removable via lock function Adjustable following wheel arch Only in combination with folding backrest! anthracite, matt in frame colour (basic colour with two-colour design) in design colour (only possible with frames in twocolour design) Carbon clothing guard removable via lock function Adjustable following wheel arch Only in combination with folding backrest! Rear seat height approx. 39 to 43 cm (for 24" wheel) Long axle plate Rear seat height approx. 43 to 47cm (for 24" wheel) Removable wheelbase extension Speedy 4all / 4you Wheel position displacement approx. 14 cm 4 camber integrated, adjustable track Wheel camber Total width with tight mounted hand rim 1 drive wheel camber Total width = approx. SB + 20 cm* 4 drive wheel camber Total width = approx. SB + 26 cm* 6 drive wheel camber Total width = approx. SB + 30 cm* E-adaptions Preparation for "e-motion" mounting Equipment: e-motion torque support, 1/2" axle and socket length 50.8 mm (2") Pro Activ and Alber recommend that antitipping supports are installed in pairs for wheelchair equipment with e-motion. Under the selection "Adaptation", please select the equipment und ! / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
6 Preparation for "e-fix" mounting Equipment: 1/2" axle, socket length 50.8 mm (2") and e-fix torque support. Pro Activ and Alber recommend that antitipping supports are installed in pairs for wheelchair equipment with e-fix. Under "Adaptation", please select the equipment e- fix Art.-Nr.: ! Please order anti-tipping support e-fix with "Standard fork" direct from Alber. Wheelchair delivery to Alber GmbH specialist dealer Brake system Brake system push to lock Standard brake handle Brake system push to lock Long brake handle Brake system push to lock Low brake handle Brake handle angle Space-saving; recommended for users with slight motoric disabilities. Only compatible with brake system push to lock with standard brake handle, long brake handle or low brake handle. Brake handle to Flip-down Length: 9cm Drum brake Operating from the push handle Total wheelchair width (see selection "Wheel camber") + 3cm! Depending on the seat height, the long wheel plate is mounted in order to protect the drum brake anchors. Only in combination with 36 spoke drive wheel aluminium rim and hub in silver. Not in combination with one arm drive, e-fix or e-motion! Footrest Continuous footrest with tubular resting bracket height adjustable +/- 3 cm for KW 95 from USL 34cm for KW 105 from USL 39 cm For equipment of the foot bracket with "Rubber coated footplate", please select under "Footrest accessories". Footrest folding up to one side with continuous tubular resting bracket, height adjustable +/- 3 cm, can be swung away, cannot be removed for KW 95 from USL 37cm for KW 105 from USL 42cm with V-shape from SB 40cm For equipment of the foot bracket with "Rubber coated footplate", please select under "Footrest accessories". Footrest folding back to the rear with locking mechanism with tubular resting bracket minimum USL 42cm For equipment of the foot bracket with "Rubber coated footplate", please select under "Footrest accessories". Footrest folding back to the rear with continuous tubular resting bracket and 20 mm operating lever for KW 95 from USL 38cm for KW 105 from USL 42cm with V-shape from SB 33 cm with V-shape from SB 38 cm For equipment of the foot bracket with "Rubber coated footplate", please select under "Footrest accessories". Divided Footrest with rubber coated footplate, height adjustable +/- 3cm, angle adjustment, can be pivoted outwards and folded up to the side, including frame reinforcement for KW 95 from USL 37cm for KW 105 from USL 42cm with V-shape from SB 40cm "Swing away" footrest with rubber coated footplate, separated in the middle, can be folded to the side, removable, can be folded up, height-adjustable, angleadjustable including frame reinforcement from USL 34 cm / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
7 Footrest accessories Rubber coated footplate bolted, angle-adjustable Depth: 14cm In combination with tubular bracket Art.-no , or ! Footplate side stop adjustable Only in combination with rubber coated footplate! Adaptations Anti-tipping support right side left side with tension spring and universal adapter pivotable (for optimum pivoting behaviour, the seat slope should be >3 cm) Universal adapter prepared for e-fix anti-tipping support equipment Universal adapter is prepared for the assembly of the e-fix jack-up anti-tipping support. Supplied completely mounted, without antitipping support and anti-tipping support mount. On the customer side, please order the antitipping support by Alber! Transit wheels with universal adapter, removable (not in combination with anti-tipping support) Tilting clamp right side left side with universal adapter and Quick pin (not in combination with anti-tipping support, right side or left side) Caster wheels All caster wheels (except pneumatic tyres) are puncture proof! 4" Caster wheel "Standard" black (82A), 5" Caster wheel "Standard" grey (82A), 5" Caster wheel "Standard" black (82A), 6" Caster wheel "Standard" (82A), 5" Lenkrad "2 components" " Caster wheel "Pneumatic tyre" " Caster wheel "Flexel System" " Skate wheel (80 mm) " Skate wheel (100mm) Safety light-up wheel 4" (100mm) Safety light-up wheel 5" (125mm) " Aluminium rim 3-spoke design "easy running" with replaceable rubber race 3 mm, hard, silver, anodised black " Aluminium rim 3-spoke design "good shock absorption" with replaceable rubber race 6 mm, medium hard, silver, anodised black / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
8 Frog Legs-Caster wheel 4" (ø100x32) " (ø125x32) with replaceable rubber race, black, puncture proof, 3-spokes, rim: silver Caster fork Caster fork colours, see "Component colours" Drive wheels Information on further rim types, versions and avaiabilities under Drive wheel, 18 spoke aluminium rim with aluminium front hub, spoked radially Only up to a body weight of 70 kg, not with tyres, not suitable for bike mode. Caster fork Standard with screwed axle with quick-release axle Caster fork "Heavy duty" for high loads Extra weight approx g with screwed axle with quick-release axle Suspension fork with screwed axle and 5" Aluminium rim "good shock absorption" with quick-release axle and 5" Aluminium rim " good shock absorption" Caster fork spare wheel with quick-release axle Article is without caster wheel. In case a caster wheel is requested, please put a cross on a second selection in the category Caster wheels Track distance Caster wheel track extension 10mm per side mm per side mm per side Drive wheel, 36 spoke aluminium rim with aluminium front hub, spoked radially Drive wheel double rim 36 spokes (ETRTO 559) (ETRTO 590) with aluminium front hub, spoked radially Use with higher loads and body weight > 120 kg! Spinergy running wheel "Spox Sport" with 24 PBO spokes; rim, hub and spokes in black (ETRTO 559) (ETRTO 590) Spinergy "Everyday Light Extreme" with 12 PBO spokes; rim and hub in black, spokes white Spinergy "Everyday Light Extreme" with 12 PBO spokes; rim, hub and spokes in black / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
9 Handrims x = dimension handrim attachment! Handrim : Curve Handrim attachment: attachment: x = 11mm x = 10mm x = 19mm x = 18mm If no specification is given, the handrims will be mounted wide (19mm/18mm). Ø 20 mm stainless steel handrims Ø 19 mm aluminium handrims silver anodised Ø 19 mm aluminium handrims powder coated in the frame colour (Basic colour in two-colour design) = surface gloss = surface matt Please note: coating in matt is because of the minimal Grip not recommended Ø 19 mm aluminium handrims polished and hard-anodised Ø 19 mm titanium handrims Ultra-Grip handrims "very good grip" Ergo-Grip handrims Resting attachment to the rim! Dual-Grip handrims Silicone handrim covers for 24" hand rim for 26" hand rim Surface without structure, compatible with handrim Ø 19mm or Ø 20mm. Curve handrim, black anodised, ergonomic handrim profile H 24mm H 31mm Size L H 31mm Size L Curve handrim powder coated, ergonomic handrim profile = frame colour (surface gloss) = black (surface gloss) Please note: coating in matt is because of the minimal Grip not recommended. H 24mm H 31mm Size L H 31mm Size L Curve Grip handrim, Tetra-Grip coated, ergonomic handrim profile H 31mm Size L Quadro handrims, Tetra-Grip "very good grip" for 24 and 25" wheel / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
10 Gekko handrims for 24 and 25" wheel Black anodised with strong and exchangeable rubber completely integrated in the handrim profile Equipment without handrims Spoke guard Finger- and spoke guard "transparent" for 24" wheel Design and spoke protection film "basket" Only in combination with finger and spoke protection! Design and spoke protection film "silly-bubble" Only in combination with finger and spoke protection! Design and spoke protection film "blue-sky" Only in combination with finger and spoke protection! Design and spoke protection film "colour-stones" Only in combination with finger and spoke protection! Tyres Schwalbe "RightRun" High-pressure tyre 7.5 bar 24x1 (540-25) x1 (559-25) x1 (590-25) Schwalbe "DownTown" Tread tyre 7.5 bar 24x1 (540-25) Schwalbe "MarathonPlus Evolution" with "smart guard" puncture protection 24x1 (540-25) x1 (559-25) x1 (590-25) Colour: black 10 bar Schwalbe "MarathonPlus" with "smart guard" puncture protection 24x1 (540-25) Colour: grey, black wall, 10 bar Schwalbe "Airborne" x1,2 (540-20) Colour: black Puncture-proof tyre "solid-rubber tyres" 24x1 (540-25) Colour: black Not in combination with the 18 spoke drive wheel! Puncture protection belt for pneumatic tyres Accessories 24 MTB spare wheel set with double rim (ETRTO 507), aluminium front hub, quick-release axle and stainless steel hand rim Mountain bike tyres, selectively: x1.75" Continental "RIDE Tour Trekking" Brake setting compatible with 24x1" wheel x1.75" Continental "Explorer" Brake setting not compatible with 24x1" wheel x2.1" Schwalbe "SMART SAM Sport" Brake setting not compatible with 24x1" wheel ATTENTION: we charge a surcharge of for the use of drum brakes / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
11 Lockable drive wheel axle clip "Tetra Clip" Your additional notes: Not for Spinergy drive wheels! Hand air compressor with pressure gauge up to 14 bar Adjustable safety belt with belt buckle Adjustable safety belt with hook and loop fastener Crutch holder with nylon cup flexibel Light set with battery and charger Transport bag for drive wheels for 24" wheel Ø76cmx2cm Ø83cmx2cm Accessory bag cm x 13cm x 5cm Further accessories, e.g. adaptive bikes, steering attachments, etc. see separate dimension sheet or I herewith confirm the details listed above Location, Date Signature (End customer) Location, Date Signature (Dealer) / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected
Invoice address: same as company address. Invoice address: other (see below) Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact:
Im Hofstätt 11 D- 72359 Dotternhausen Tel +49 (0)7427 9480-0 Fax +49 (0)7427 9480-7025 e-mail info@proactiv-gmbh.de www.proactiv-gmbh.de Quotation date: Order date: according to GTC PRO ACTIV GmbH TRAVELER
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Manual Wheelchair Retail Prescription Form ACTION3JUNIORSMALL19102018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer
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MASS Script Form Australian Order Form Effective 05/07/2014 Company: Account Number: Date: Quote PO Number: RTS: Marked For: Ship To: Address: City: State: Zip: Phone: Email/Fax: Catalyst 5Vx K0005 Charge
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EVO CEV Order form Dealer 2017 EVO Dealer: Date: Dealer reference / Client name: Order number: Anglikerstrasse 20 CH-5610 Wohlen Phone: +41 56 618 44 11 Fax: +41 56 618 44 10 e-mail: office@levo.ch configuration
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Manual Wheelchair Retail Prescription Form ACTION4NGHD11112016 Tel: 01656 776222 Fax: 01656 776220 JAN 2017 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Customer Ref: Contact
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