Zippie TS SE January 2019 EIZ1A

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1 a ST: Dealer Phne: ( ) Fax: ( ) ZIP: SUBMITTING FOR: Qute Order Fax Ship T Phne: ( ) Fax: ( ) Flding Grwing Zippie TS SE Withut Seating 187WM67 E1234 Transit Optinal $2,575 True Fit Nt Included Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: Cnfirm Via: Mark Fr: 187WM68 E1233 Base Mdels Rigid Grwing Zippie TS SE Withut Seating Transit Optinal True Fit Nt Included 187F02 Additinal Rigid Strut Tube Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 15"-18" widths = E1161 Zippie TS SE January 2019 EIZ1A Price a Optin # HCPCS 1. FRAME All Zippie TS mdels grw in width and depth. $2,450 ST: ZIP: Tie Dwn Requires: Slid Seat and Slid Back r Grwing Seat Pan and JAY Fit r Cnventinal Seat and Back r Grwing Seat Pan and Slid Back r JAY Fit and/r Cnventinal Seat & Back 2. SIZE/SEATING 187TO12 K TO11 187TO20 187TT12 187VZ01 187VZ02 187TT8 PO#: Ship T: Attentin: Address: Address: Ship T City: 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. Optin # HCPCS Definitin ZIPPIE TS SE Transit System (Fr use when Transit Optinal is selected) Transit Optinal Seating (Req. Selectin f Seat & Back) K0108 Transit Optinal w/ Seating $250 Transit Omit N/C Tilt Optins Dual Trigger Cable Release Crisscrss Cables (cables are lnger individually) Nn-crisscrss Definitin Cable Ft Release (may limit flding width) Price $250 Std 187W25 187S1 187S2 187S3 187W26 187S3 187S4 187S5 187W27 187S5 187S6 187S7 187W28 187S7 16" 187S8 187S9 Frame Width Small Crss Brace 10" 11" 12" Medium Crss Brace 12" 13" 14" Large Crss Brace 14" 15" 16" X-Large Crss Brace 17" 18" 187FD4 187FD5 187FD6 187FD7 187FD8 187FD9 187FD10 187FD36 Frame Depth and Back Pst Lcatin 13" Frame Depth 14" Frame Depth 15" Frame Depth 16" Frame Depth 17" Frame Depth 18" Frame Depth 19" Frame Depth (uses rear frame extensin plug) 20" Frame Depth (uses rear frame extensin plug) Figure Frame Depth Diagram Units are in inches. Custmer Service: Fax: rders@sunmed.cm Web: Page 1

2 2. SIZE/SEATING CONT. Seats REFEREE ONLY 187ST55 187ST14 187ST5 E2231 E2231 Slid Seat (Requires Slid Back, w/ 10"-13" Wide x 19"-20" Frame Depth r 17"-18" Wide x 13"-17" Frame Depth) Grwing Seat Pan Depth (Fig. 7.1) Omit Seat Std Seat Depth Pan Size Medium 13"-14" Lng 15"-17" X-Lng 18"-20" Minimum 11-3/4" 13-3/4" 15-3/4" Depth Range Maximum 16-1/4" 18-1/4" 20-1/4" JAY Cushins (Optinal) 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. 187JC20 JAY Bundled Cushin Name / Part # Width (in.): Depth (in.): Price List Depth Figure Frame Depth Grwth Range Matrix Caster Wheel Rear CASTER SIZE Wheel Sme interference may ccur when chsing 8" Caster w/ Z-Finity Size 3" 4" 5" 6" 8"x1" 8"x1.5" 8"x2" 187CW30 3" Micr Light Up $ " 16.5" 16.5" 17.0" 187CW31 4" Micr Light Up $70 12" 17.5" 17.0" 17.0" 17.5" 187CW51 5" Micr Light Up $ " 17.5" 18.5" 18.0" 18.5" 187CW5 5" Lw-Prfile Plyurethane 12" 16.0" 16.0" 16.0" 187CW7 E2219 5" x 1.5" Semi-Pneumatic $85 Lw Ply 16.5" 16.5" 16.5" 16.5" 15.5" 15.5" 15.5" 187CW33 6" Pneumatic E " 18.0" 18.0" 18.0" 18.0" 18.5" 18.0" 18.5" 187CW34 6" Plyurethane 18.5" 18.5" 18.5" 18.5" 19.0" 18.5" 187CW35 E2219 6" x 1.5" Semi-Pneumatic $ " 15.5" 15.5" 187CW21 18" 16.0" 16.0" 16.0" 16.5" 16.5" 16.5" 187CW32 8" Plyurethane 17.0" 187CW39 E2219 8" x 1.5" Semi-Pneumatic $ " 15.5" 15.5" 187CW36 187CW37 E2215 E2215 K CS3 K0073 8" Pneumatic $85 8" x 2" Pneumatic 8" x 2" Pneumatic w/ Airless Insert Caster Optins Caster Pin Lcks ( with 8" x 2" and 8" x 1.5" casters) $145 $225 $ CASTERS 20" 22" 24" 16.0" 16.0" 16.0" 16.5" 16.5" 16.5" 16.5" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 18.5" 18.5" 16.5" 16.5" 16.5" 16.5" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.5" 18.0" 18.0" 18.0" 18.0" 18.5" 18.5" 19.0" 18.5" 18.5" 18.5" 18.5" 19.0" 17.0" 19.0" 19.0" 19.0" 19.5" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 18.5" 18.5" 18.5" 18.5" 18.5" 18.5" 18.5" 19.0" 19.0" 19.0" 19.0" 19.0" 19.0" 19.5" 19.5" 19.5" 19.5" 20.0" 16.5" 20.0" 20.0" 18.0" Chart A - Seat t Flr Height Matrix Nte: Rear seat-t-flr ht. may be up t 1.5" lwer than frnt seat-t-flr ht. 18.5" 18.0" 19.0" 20.0" 18.5" Custmer Service: Fax: rders@sunmed.cm Web: Page 2

3 4. REAR WHEELS / SEAT HEIGHT 187RW13 187RW14 187RW3 187RW8 187RW1 187RW12 187RW90 187RW91 187RW54 187RT1 Rear Wheel Size 12" Mag ( with handrims) 16" Mag ( with handrims) 20" Mag 22" Mag 24" Mag 18" Spke 20" Lite Spke 22" Lite Spke 24" Lite Spke Rear Wheel Tire Pneumatic 187HR1 187HR4 187HR7 187HR8 187AX26 187AX1 187AX11 Aluminum Andized Plastic Cated Omit ( with wheel/axle credit) *Only available with 24" wheels & with spke guards. 8 Oblique Handrim Prjectins ( n Plastic Cated) Axle One-Arm Drive Axle (Only avail. w/ One-Arm Drive Optin) Quick Release Quad Quick Release ( with Lite Spkes) $325 $ RT2 187RT3 187RT4 187RT6 E2211 E2213 E2211 E2212 Pneumatic Airless Insert Full Plyurethane ( w/ 12", 16" and 18" rear wheels) Lw Plyurethane (Only available with 12" r 24" wheels ) High Pressure Clincher (Only available with 24" spke wheels) $85 $95 187AL18 187AL34 187AL35 187AL17 187OA2 187HM1 187HM2 187OA1 187HM1 187HM2 Right Left Axle Plate 12" Rear Wheel Axle Plate (Only avail. w/ 12" r 16" rear wheels) Shrt Adjustable ( with 12" rear wheels) Lng Adjustable ( with 12" rear wheels) Small Handrim ( w/ 20" wheels) One Arm Drive E0958 (Avail. w/ 20", 22", 24" Mag Rear Wheels $900 & 13"-18" width) Standard Handrim Right Left 5. WHEEL LOCK / HUB LOCK 187WL1 187WL2 187WL25 187WL10 Wheel Lck with Hub Lck High Munt Push High Munt Pull Ft Lck (may limit flding width) Omit 187LK01 187LK02 Hub Lck *Only available with 12" r 16" wheels. w/ One-Arm Drive. 12" Hub Lck 16" Hub Lck 187EH1 E0961 Extensin Handle 6" Pair Custmer Service: Fax: rders@sunmed.cm Web: Page 3

4 6. FOOTRESTS Hanger Munted Ftrest (Ftplates Munt t Hanger Tubing) 187H H H H9 187H10 187H11 187H161 Extensins (may interfere with sme seat heights & casters) 187E23 2" (nt munted) 187E24 4" (nt munted) Ftplate 187F9 187F8 187F62 187H H H E1 187E2 187E5 187E16 Hanger Type 70 Swing In/Out Frnt Munt 80 Swing In/Out Frnt Munt 90 Swing In/Out Frnt Munt 70 HD Frnt Munt Lift-Off 80 HD Frnt Munt Lift-Off 90 HD Frnt Munt Lift-Off Kids Angle Adjustable ( w/ 17"-18" widths) Adult Angle Adj. (Available with 10"-18" widths) Ext. Tube Munted Ftrests (Ftplates Munt t Ext. Tube) 187H F3 E0990 K0053 Ftbard (Available with 10"-16" widths) Hanger Type 60 Swing In/Out 70 Swing In/Out 80 Swing In/Out Articulating ( w/ 10"-13" cmpsite ftplates) Lng (17" - 19") High Munt Ftplate $295 Elevating ( w/ cmpsite r platfrm 187H160 E0990 $295 ftplates, r <16" width) 187F1 90 Elevating ( w/ 10"-11" Wide r Z-Finity) Extensins Shrt (11.5" - 14") Med (14" - 17") - ( w/ ELR) Cmpsite ( In 10", 11" r 12" width) Aluminum Angle Adjustable $190 $370 Z-Finity Hangers/Ftrest System Sme interference may exist in certain cnfiguratins. 187H162 Z-Finity Hanger Z-Finity Ftrest Munt (Must Chse see Illustratin in appendix) 187DI22 187DI23 187DI24 Direct Hanger Mt/Fixed Frame - High Direct Hanger Mt/Fixed Frame - Lw Extensin Tube Munt Z-Finity Ftrest Pivt Arm (Must Chse, use matrix in appendix fr leg length) 187DI20 Shrt 2" 187DI21 Lng 3-1/4" Z-Finity Ftplate Sme interference may exist in certain cnfiguratins. Multi Angle Adjustable - Pair 187F320 ( w/ 8"-9" widths) 187F321 Angle Adjustable Platfrm Ftbard $ F6 Omit Ftplate Z-Finity Extensin Tube Length (When Chsing Ext. Tube Munt) 187E62 Hemi 187E1 Shrt 187E2 Medium 187E5 Lng Direct Hanger Munt Extensin Tube Munt 187F4 Kids Angle Adjustable ( w/ 17"-18" width) 187F5 Aluminum (Only available with elevating leg rests 14"- 18") Platfrm Flip-Up 187F48 (Available n 60, 70, and 80 ext. $190 munt hangers nly) 187IG2 Ftrest Hanger Optins Neprene Cvers (Avail. On 60 / 70 /80 ext. munt hangers nly and Z- Finity except in highest munted psitin). $90 187HL1 E0951 Heel Lps ( w/ Z-Finity widths belw 14") $40 187A110 E0952 Te Lp (Only avail. w/ adult angle adjust. Ftplates w/ Z-Finity) 187HL5 187A55 187H32 K0038 Leg Strap Extra Leg Strap Omit Hanger $40 $35 -$15 187F7 187HL4 Omit Ftplate & Ext. Tube Omit Heel Lp -$15 187HL6 Omit Single Leg Strap $40 Custmer Service: Fax: rders@sunmed.cm Web: Page 4

5 7. BACKREST / SEATING 187PU4 187PU5 187PU6 187PU9 Backs (Slid Back Depth = 2" Less Than Frame Depth) Shrt Slid Back 12" (Requires slid seat) Med. Slid Back 14" Tall Slid Back 16" Omit Backrest JAY Backs (Optinal) Ordering JAY backs n-chair, See the JAY Price List. Requires Part # JAY Bundled Backrest 187JB02 Backrest Name r Part # Price List Width (in.): Height (in.): Strller Handle Back Psts - Backrests 187BP9 187BP10 187BP11 187BP13 187RG1 Fixed Height Lw (19" Height) Medium (22" Height) Tall (25" Height) Remvable Extensin Flding Adjustable Rigidizer $85 $175 Height Adjustable Rigid Frame w/ Angle Adjust Push Handle 187B202 Std. (16"-22" Height) 187PH8 Std. Angle Adj. Push Handle Length 187PH9 Lng Angle Adj. Push Handle Length 187B PH8 187PH9 187B BP47 187B BP47 Tall (19"-25" Height) Std. Angle Adj. Push Handle Length Lng Angle Adj. Push Handle Length Flding Frame with Push Handle Std. (17"-23" Height) Swing Away Handle ( with dual triggers) Tall (20"-26" Height) Swing Away Handle ( with dual triggers) Fixed Rigid FIGURE HANDLE HEIGHT DIAGRAMS Flding Custmer Service: Fax: rders@sunmed.cm Web: Page 5

6 8. ARMRESTS / SIDEGUARDS Armrest and Armpad - Height Adjustable Armrest Receiver fr Height Adjustable Armrest 187AA12 T-Pst Regular w/ Fam $ AR17 Lw ( w/ 20", 22" & 24" wheels) 187AA13 T-Pst Tall w/ Fam $ AR18 Standard 187AA3 Flip-Up 187AA1 Adjustable Lcking Flip-Up $265 Side Guard 187AA7 Length Adjust. Lcking Flip-Up $275 ( with height adjustable armrests r T-Pst armrests) 187AM23 187AM24 187AM9 Desk Length - 10" Full Length 14" Fam Shrt ( w/ T-Pst) 187SG33 187SG29 K0108 Plastic Std $140 K0108 Plastic Lw $ AM10 Fam Lng ( w/ T-Pst) Armrest - Height Adjustable 187AA11 Single-Pst Height Adj. Std. $ AM23 Desk Classic 187AM21 Desk Cntur 187AM24 187AM22 187AA29 Full Classic Full Cntur Single-Pst Height Adj. Lw $ AM23 Desk Classic 187AM21 187AM24 187AM22 Desk Cntur Full Classic Full Cntur Armrest Size Transfer Tube Length (D) Receiver CLASSIC PAD Pad Length (L) Height Range (H) Desk Full 8" 5-1/4" 10-3/4" t 15-3/4" 8-3/4" t 13-3/4" 9" t 13" 7-1/4" t 11-1/4" 10-1/4" 14" CONTOUR PAD Armrest Size Transfer Tube Length (D) Receiver Height Range (H) Pad Length (L) Desk Full 8" 5-1/4" 10" t 15" 8-1/4" t 12-1/2" 8-1/2" t 12-1/2" 6-3/4" t 10-3/4" 10-1/2" 14-1/4" Armrest Matrix fr Single-Pst Custmer Service: Fax: rders@sunmed.cm Web: Page 6

7 9. KEY OPTIONS 187A1 187A2 187A8 Back Pack (Kids Backpack included) Utility Backpack - Black Additinal Kids Black Backpack Seat Puch Black $60 $50 Psitining Belt (w/ clamps) 187A112 E0978 1" Dual Pull Side Squeeze Padded $85 187A117 E0978 Belt 2" Aircraft Buckle $ A118 E0978 Belt 2" Aircraft Buckle Padded $ A141 E0978 Belt 1.5" Aut Buckle w/ Clamps $70 187A814 E0978 1" Cmfrt Fit APB5116 $ A83 Tl Kit Miscellaneus $45 Canpy (SunShade) (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) 187AT1 E0971 E0971 Spke Guard ( with 12", 16" and 18" rear wheels & Prjectins Handrims) 187A23 K0065 Black $ A24 K0065 Clear Zippie $ AO1 Anti Tips Frnt Anti-Tip ( with caster pin lcks) ( with transit ptin) Rear Anti-Tip 1878A A07 K0108 K0108 Canpy (Sunshade) 10"-14" Width Canpy (Sunshade) 15"-20" Width Upper Extremity Supprt Tray When rdering a tray with full armrest r desk armrest pads, add 1" t seat width t determine best tray size. $275 $275 $ A29 187A30 187A31 E0950 E0950 E0950 X-Sm (Suggested 10"-12" Width) Sm (Suggested 13"-14" Width) Med (Suggested 15"-17" Width) $255 $255 $255 $ A32 E0950 Lrg (Suggested 18"-20" Width) $ FRAME COLOR Standard Clrs 187C140 Aztec Gld 187C2 Black ( as base w/ Zebra) 187C141 Black Cherry 187C10 Black Opal 187C38 Blue Opal 187C36 Candy Blue 187C14 Candy Purple 187C35 Candy Red 187C142 Electric Blue 187C143 Evergreen 187C126 Glw 187C144 Green Apple 187C147 Ht Sparkle Pink 187C148 Mauve Pink 187C103 Rtbeer 187C114 Sparkle Silver 187C145 Sunrise Orange 187C113 Titanium Clr Paint 187C8 Yellw 187C C C C C C42 187C108 Cmmnly Requested Optins Include: Dynamic Back Reclining Backrest Custm Andizing Custm Paint O2 Hlder with Transit IV Ple with Transit Standard Matte Clrs Matte Black Matte Black Cherry Matte Purple Matte Electric Blue Matte Evergreen Custm Clrs 187C43 Mssy Oak Camuflage $395 Stars and Stripes Zebra (Chse base clr abve: White Std. black, black pal, matte black r titanium) Additinal Optins Thrugh Built-4-Me T inquire abut any unique custmizatin fr Zippie prducts, cntact: Phne: (800) , Fax: (800) $395 $395 Sunrise Medical (US) LLC 2842 Business Park Ave. Fresn, CA USA Custmer Service: Fax: rders@sunmed.cm Web: Page 7