Quickie Q7 Active Rigid January 2018

Transcription

1 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Cnfirm Via: ZIP: Fax Ship T Phne: ( ) Fax: ( ) a 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 Quickie Q7 Active Rigid January 2018 Price EIR4 Optin # 1. FRAME STYLE & SETUP PO#: Ship T: HCPCS ADDITIONAL SHIPPING INFORMATION ST: Definitin ZIP: Price Fr sizes 14" r less please use HCPCS E1235 Quickie Q7 - Welded 186WM61 K0005 Weight capacity 265 lbs. Base Mdel $2, Perfrmance Package (N substitutins, discunt given n separate line) 186QD01 Single Sided Frk Ultra Lightweight Wheel Schwalbe Marathn Plus Evlutin Cmpact Wheel Lck Retail Value $ Package Price $ Frame Angle See FIGURE 1. Measure frm frnt frame t flr. 186FA1 186FA8 186FA Frame Inset Per Side See FIGURE 2. Frame Inset is the distance frm the utside f the seat tube t the utside f the ftrest. 186FF1 186FF2 186FF3 0" 1" (N/A w/ 12" wide) 2" (N/A with 12" & 13" wide) Ultra Lite Package (N substitutins, discunt given n separate line) 186QD02 Ultra Lite Seat Sling $ Ultra Lightweight Wheel Schwalbe Speed Run Tire Cmpact Wheel Lck Retail Value $ Package Price $ IN04 Attitude Bike (Optinal) Attitude Bike bundle See Order Frm Frame Style See FIGURE 3. Measurement fr set up. 186FS9 Standard 186FS34 Classic * Standard Frame - Seat Sling t frnt frame bend angle is 1.5" shrter than the classic psitin. Classic Frame - Traditinal GT seat sling t frnt frame bend angle dimensins. Frnt f back cane pst t frnt edge f seat sling will remain the same fr bth Standard and Classic. See FIGURE 4 186LH01 186LH02 186LH03 Caster Husing Psitin Setting 1 Suggested fr 3" & 4" casters. Fr 2" Inset N/A w/ setting 1 Setting 2 Suggested fr 5" & 6" casters. Setting 3 N/A w/ 6" casters Figure 1 Figure 2 Figure 3 Figure 4 Custmer Service: Fax: rders@sunmed.cm Page 1

2 1. FRAME STYLE & SETUP (CONT.) Frame - Direct Munt Wheel Lck (Optinal) Seat Depth N munting clamp hardware. Only available with Cmpact Wheel Lck and 0 Camber. Nt available with muntain tires r rear suspensin. Traditinal wheel lcks available, see page 5. N/A with rear suspensin system. 186WH13 Direct Munt Wheel Lck Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 186S4 186S5 186S6 186S7 12" 13" 14" 15" 16" Figure 6 186S8 186S9 186S10 186S48 17" 18" 19" 20" (E2201) See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 186SD5 186SD6 186SD7 186SD8 186SD9 186OP01 12" 13" 14" 15" 16" 186SD10 186SD11 186SD12 186SD13 17" 18" 19" 20" (E2203) Seating Systems Standard Seat Sling $ Ultra Seat Sling 186OP02 Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. 186OP04 Omit Seat Sling $ $ Figure 7 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 JAY Bundled Cushin 186JC20 Cushin Name r Part # Price List Width: Depth: 2. FRONT SEAT HEIGHT SET UP Frnt Seat Height See FIGURE 8 Measure frm the frnt f the seat rail t the flr. 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " Figure 8 186CW1 186CW3 186CW31 186CW72 186CW44 186CW64 186CW5 186CW51 186CW6 186CW65 186CW7 186CW66 186CW34 186CW33 186CW35 186CW68 Caster Wheels 3" Micr 4" Lw Prfile Plyurethane 4" Micr Lighted 4" x 1" Aluminum Ply E2219 4" x 1.25 Semi Pneumatic 4" x 1.5" Aluminum Sft Rll 5" Lw Prfile Plyurethane 5" Micr Lighted E2219 5" Sft Rll (Grey) -N/A w/frg Legs 5" x 1" Aluminum Ply E2219 5" x 1.5" Semi Pneumatic 5" x 1.5" Aluminum Sft Rll 6" Ply E2214 6" Pneumatic E2215 E2219 6" x 1.5" Semi Pneumatic 6" x 1.5" Aluminum Sft Rll 186CF74 186CF65 186CF69 186CF53 186CF54 186CF55 Caster Frks and Suspensin Carbtecture Frks Multiple Psitin Multiple Psitin Single Sided Frk E1015 Frg Legs 0 weight t 100 lbs. E1015 Frg Legs 101 lbs. weight t 190 lbs. E1015 Frg Legs 191 lbs. weight t 265 lbs. Custmer Service: Fax: rders@sunmed.cm Page 2 $ $55.00 $ $ $ $75.00 $ $150.00

3 3. FOOTPLATE OPTIONS Ftrest 186F229 Aluminum Tubular 186F274 Aluminum Tubular w/ Snap On Cver $ F276 K0040 Angle Adjustable Flip Back $ F51 K0040 Platfrm Ftrest 186F AD1 186AD2 186AD3 K0040 Ultra Lite Platfrm Ftrest N/A w/ 14" wide and 2" inset, N/A w/ wide w/ 0" inset Adaptive Platfrm Spacer N/A with Aluminum Tubular r Ultra Lite Platfrm. Nw available with Angle Adj. Flip Back. Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer Ftrest Optins 186DI08 High Munt Ext Tubes (N/A w/ Tubular ftrest) $ DI03 K0038 Leg Strap $ DI04 K0038 Extra Leg Strap $ DI05 Gel Hanger Cver $ DI07 Neprene Impact Guards 186DI02 Wear Pads 186DI06 Psitin Plates (N/A fr Tubular Ftrest) 4. BACKREST Back Type See FIGURE 9 Chse backrest psitin. 0 Equal is perpindicular t flr, + means frward Active Fixed Backrest 186BT97 Setting PH5 186PH2 Backrest Handles Fld Dwn Push Handles N/A w/ 8"- 10" fixed height N/A w/ standard uphlstery Omit Push Handles $ Figure 9 Backrest Uphlstery 186BU1 Standard Uphlstery 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $ BU71 E2611 Backrest Tensin Adj 3DX Vented $ BU14 Omit Back Uphlstery -$15.00 Ultra Lightweight Aluminum Fixed Backrest JAY J3 Back J3 Back T rder a J3 Back please select Omit Back Uphlstery. See J3 Back Order Frm fr Part #'s Price List Select back height. 8", 9", r 10" nly available with mit push handles. 17", 18", r 19" nly available with fld dwn push handles Military Service Patches 186BB21 8" $ BB17 14" $75.00 Only available n tensin adjustable uphlstery and Jay 3 Back 186BB20 9" $ BB18 15" $ VU1 US Marines Patch 186BB13 10" $ BB19 16" $ VU2 US Army Patch 186BB14 11" $ BB10 17" $ VU3 US Navy Patch 186BB15 12" $ BB11 18" $ VU4 US Air Frce Patch 186BB16 13" $ BB12 19" $ VU12 Cast Guard Patch Twel Bar 186VU5 186VU8 Purple Heart Patch Purple Heart with Marines Patch 186QT01 Standard Style - 4" Offset 186VU9 Purple Heart with Army Patch 186QT02 Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with 19" & 20" wide 186VU10 186VU11 186VU13 Purple Heart with Navy Patch Purple Heart with Air Frce Patch Purple Heart with Cast Guard Patch 186JB01 5. REAR SEAT HEIGHT SET UP 186AL57 Axle Plate Active Rigid (.5" t 4") Adjustment range 1/2" fre and aft in 1/4" increments except the.5" and 4" psitins which are maxed Measure frm frnt f back pst t the center f rear axle. N additinal rearward adjustment when.5" chsen. N additinal frward adjustment when 4" chsen. 186CC1.5" 186CC2 1.0" 186CC3 1.5" 186CC4 2.0" 186CC5 2.5" 186CC6 3.0" 186CC7 3.5" 186CC8 4.0" Center f Gravity Preset Custmer Service: Fax: rders@sunmed.cm Page 3

4 5. REAR SEAT HEIGHT SET UP (CONT.) See FIGURE CI1 186CI2 186CI4 Camber 0 3 6º (N/A with Std Mag and 5 spk MAG Wheels ) Figure 10 Frnt t Rear Seat Height Matrix 12" Seat Depth 2.5" Max Frnt t Rear Seat Hgt. 13", 14" Seat Depth 3.0" Max Frnt t Rear Seat Hgt. 15", 16" Seat Depth 17", 18" Seat Depth 3.5" Max Frnt t Rear Seat Hgt. 4.0" Max Frnt t Rear Seat Hgt. 19", 20" Seat Depth 4.5" Max Frnt t Rear Seat Hgt. Rear Seat Height 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20", 22" Rear Wheel 15.5" Only w/ 20" r 22". Limited 186RH16 availability w/ 24" depending n seat squeeze. 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " Wheel 5 Spke Ultra Mag Lite Spke Tire Mag Lt wt Spinergy Full Ply Tire 20,22,24 20,22,24 20,22,24 High Press. Clincher 22,24,25,26 22,24,25 22,24,25,26 SHOX Perfrm. Ply 20,22, ,25 24,25 Knbby V-TRAK Pneumatic 20,22,24 20,22,24 20,22,24,26 22,24,26 Pneumatic w/airless Insert 20,22,24 20,22,24 20,22,24,26 22,24,26 Schwalbe Marathn 24,25,26 22,24,25 24,25,26 Schwalbe Speed Run 24,25 24,25 24,25 22" = 489 mm 24" = 540 mm 25" = " = AX13 Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Cntact Built 4 Me fr Spinergy clr ptins r Tplin Carbn Wheels. 186RW3 186RW8 186RW1 186RW RW RW RW90 186RW91 186RW92 186RW93 186RW94 186RW06 186RW10 186RW16 186RW28 186RW95 186RW96 186RW97 186RW32 20" Mag 22" Mag 24" Mag 20" Mag Wheel 5 Spke 22" Mag Wheel 5 Spke 24" Mag Wheel 5 Spke 20" Lite Spke 22" Lite Spke 24" Lite Spke 25" Lite Spke 26" Lite Spke 22" Ultra Lightweight Spke " Ultra Lightweight Spke " Ultra Lightweight Spke " Spinergy SPOX Black Spkes 24" Spinergy SPOX Black Spkes 25" Spinergy SPOX Black Spkes 26" Spinergy SPOX Black Spkes 22" Spinergy LX Black Spkes $ $ $80.00 $1, RW98 24" Spinergy LX Black Spkes $1, RW99 25" Spinergy LX Black Spkes $1, RW40 26" Spinergy LX Black Spkes $1, RW50 24" Muntain 186RT38 186RT12 186AX1 186RT3 186RT6 186RT27 186RT1 186RT2 186RT21 186RT28 Axle Quick Release Steel Quad Quick Release Steel Only available with Std Mag Whls Rear Wheel Tire Full Ply Tire E2218 SHOX Perfrmance Ply Knbby V-TRAK by Kenda Muntain Only available in 24" E2213 High-Pressure Clincher Pneumatic Pneumatic Airless Insert Schwalbe Marathn Plus Evlutin Schwalbe Speed Run Tire Handrim Natural Fit Handrims nly available in 22", 24", & 25" Natural Fit w/ 5 spke MAG nly available in 24" 186HR1 Aluminum Andized 186HR4 Plastic Cated N/A w/ 25" & 26" Lite Spke Wheels 186HR22 186HR23 186HR30 186HR31 Natural Fit - Standard Grip Natural Fit - Super Grip Natural Fit LT - Standard Grip Natural Fit LT - Super Grip $ $ $ HR24 Spinergy Flex Rim Only available n Spinergy LX wheels 24" & 25" $ HR7 Omit Handrim N/A w/ Ultra Lightweight Wheels $80.00 $ Custmer Service: Fax: rders@sunmed.cm Page 4

5 6. ARMREST Armrest - Height Adjustable Single Pst Height Adjustable - Std 186AA11 E0973 Range 8" - 13". Adjust in 1" increments 186AA29 E0973 Single Pst Height Adjustable - Lw Range 6.5" ". Adjust in 1" increments $ $ AM23 186AM21 186AM24 186AM22 Armpad - Fr Height Adjustable Desk Length (10") Classic Desk Length (10") Cntur Full Length (14") Classic Full Length (14") Cntur 7. KEY OPTIONS & ACCESSORIES Wheel Lck Nt all wheel lcks available in all seat depths, wheel size, r COG 186WL1 High Munt Push 186WL2 High Munt Pull 186WL45 Erg Scissr 186WL30 Cmpact 186WL10 Omit Wheel Lck Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks 186EH7 E0961 Extensin Handle (Pair) 186WL12 186AT37 Wheel Lck Optins D Nt Munt Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 Black 186GE02 Matching Frame- Standard Clrs 186GE03 Matching Frame- Custm Clr Increases verall width f chair. Sme interferance may exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard N/A w/ Height Adjustable Arms 186SG29 K0108 Plastic Lw N/A w/ Height Adjustable Arms 186SG35 K0108 Anti Tips E0971 Anti Tips (Pair) Side Guards Aluminum N/A w/height Adj. Arms, High Push r Pull Wheel Lcks 186SG36 K0108 Aluminum w/ Fender N/A w/ Height Adj. Arms, High Push r Pull Wheel Lcks 186SG12 K0108 Carbn Fiber N/A w/ Height Adj. Arms, High Push r Pull Wheel Lcks $ $ $ C C C2 186C C10 186C38 186C36 186C14 186C35 186C C C C C C C C C C C8 186C44 Frame Clr Bead Blast Aztec Gld Black (Nt avail as base w/zebra) Black Cherry Black Opal Blue Opal Candy Blue Candy Purple Candy Red Electric Blue Evergreen Glw Green Apple Ht Sparkle Pink Mauve Pink Rtbeer Sparkle Silver Sunrise Orange Titanium Clr Paint Yellw Glssy White - Limited Editin Matte Frame Clrs 186C116 Matte Black 186C151 Matte Black Cherry 186C150 Matte Electric Blue 186C149 Matte Evergreen 186C152 Matte Purple 186C C43 186C42 186C108 Custm Frame Clr Desert Camuflage Mssy Oak Camuflage Stars & Stripes Zebra (Chse abve base clr) Std with White unless abve base paint is chsen N/A w/ Black Psitining Belt 186A117 E0978 Belt 2" Aircraft Buckle w/clamps 186A118 E0978 Belt 2" Aircraft Buckle Padded w/clamps 186A141 E0978 Belt 1.5" Aut Buckle Universal w/clamps Spke Guards Nt available with 5 spke MAG whls 186A23 K0065 Black Spke Guard 186A302 K0065 Quickie "Q" Clear 186A1 186A2 186A8 Additinal Pack Accessries Backpack - Adult Backpack - Kids Black Seat Puch Andized Clr Package $ Frks, Backcane Bracket, Rear Axle Clamp. N/A w/ Frg Legs and $ Carbtecture frks. Andized parts can be rdered separately 186EB07 Black 186EB08 Blue 186EB09 Green 186EB10 186EB11 Purple Red 186EB12 Ti Grey Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3, Fax: (800) $65.00 $ A A83 E2207 Miscellaneus Crutch Hlder Tl Kit $ $45.00 Sunrise Medical (US) LLC 2842 Business Park Ave. Fresn, CA USA Custmer Service: Fax: rders@sunmed.cm Page 5