discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed
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1 BITTE DETACH HIER HERE ABTRENNEN AND SEND UND BY ZU FAX OTTO TO OTTO BOCK BOCK FAXEN Base price: EUR x,xxx All prices in EUR, valid from 01/01/2012 to 31/12/2012 Order no.: discovery tmax Article number: 470G22=00000_K q Provide estimate only q Order q Attachment for custom fabrication enclosed Billing address/customer number Technische Änderungen und Druckfehler vorbehalten Technical modifications and printing errors reserved. Delivery address Sales person Name... Date Signature Standard equipment -5 tilt +50 tilt in space cable free foot release rear wheels 12", 16", 22" or 24" solid caster wheels 6", 7" or 8 single push canes push to lock, wheel lock" Ottobock 647F400DisTmax=EN adjustable push bar transport brackets side plates discovery tmax 1/7
2 tmax Kids [ ] tmax Kids Seat width (between armrests) cm / 12" 16" (seat width at outside seat rails -2,5 cm/1") Seat depth from back canes to front of the seat rails cm / 12" 16" (without back canes +2,5 cm/1") Basic Price Please choose the pre setup: tmax Kids 300 mm (12") Seat depth 325 mm (13") 350 mm (14") 375 mm (15") 400 mm (16") Seat width (between armrests) / seat width at outside seat rails -2,5 cm/1" 300 mm (12") 325 mm (13") 350 mm (14") 375 mm (15") 400 mm (16") tmax Adult [ ] tmax Adult Seat width (between armrests) (seat width at outside seat rails -2,5 cm/1") [ ] cm / 14" 18" [ ] cm / 16" 20" [ ] cm / 18" 22" Seat depth from back canes to front of the seat rails (without back canes +2,5 cm/1") [ ] cm / 12" 16" [ ] 37,5 47,5 cm / 15" 19" [ ] cm / 18" 22" Please choose the pre setup: Seat depth Seat type tmax Adult Seat Pan sizes 300 mm (12") 325 mm (13") 350 mm (14") 350 mm (14") Seat width (between armrests) / seat width at outside seat rails -2,5 cm/1" 375 mm (15") 400 mm (16") 425 mm (17") 450 mm (18") 475 mm (19") 500 mm (20") 525 mm (21") 375 mm (15") 400 mm (16") 425 mm (17") 450 mm (18") 475 mm (19") 500 mm (20") 525 mm (21") 550 mm (22") SA 10 [ ] Without Seat Pan 550 mm (22") SA 11 [ ] Seat Pan with adjustable drop hooks and countersink holes add. charge MC 41 [ ] Trapazoid interface (only in combination with seat pan SA 11) add. charge Seat cushions, see order form 647F264 (Seat pan recommended!) Seat depth Seat width (between armrests) 300 mm 400 mm (12" 16") 350 mm 450 mm (14" 18") 400 mm 500 mm (16" 20") 450 mm 550 mm (18" 22") 300 mm 400 mm (12" 16") 471C22=SS C22=SS mm 475 mm (15" 19") 471C22=SS C22=SS C22=SS C22=SS mm 550 mm (18" 22") 471C22=SS C22=SS039 discovery tmax 2/7
3 Interfaces for seating systems MC 37 [ ] Interface for Leckey Mygo (seating system see orderform Mygo 647F287) and Kimba Neo Size 2 (seating system see orderform Kimba Neo 647F411) Only in combination with tmax Kids SW 425 mm/17" (not adjustable) and seat height 425 mm/17"! Footrests have to be used from the seating system, footrests from tmax can not be used! MC 38 [ ] Interface for Leckey Kit Seat (seating system see orderform Kit Seat 647F380) Only in combination with tmax Adult SW 475 mm/19" (not adjustable) and seat height 450 mm/18"! Footrests have to be used from the seating system, footrests from tmax can not be used! Armrest and tray from tmax should be used. Not in combination with transit option! Back type SD 01 [ ] Single push handles short Height (from seat to bend handle) 530 mm / 21,2" SD 02 [ ] Single push handles long Height (from seat to bend handle) 630 mm / 24,2" SD 03 [ ] Angle adjustable push bar, short 90, Height (from seat to bend handle) 530 mm / 21,2" SD 04 [ ] Angle adjustable push bar long 90, Height (from seat to bend handle) 630 mm / 24,2" SD 05 [ ] Single push handles, height adjustable cm / 21,2" 24,2" SD 06 [ ] Push bar, height and angle andjustable cm / 21,2" 24,2" Seat to back angle (please choose pre setup) [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 Back options MD 30 [ ] Cross bar with back guide for seat shell backs (Only in combination with single pushhandel and push bar height adjustable SD 05 / SD 06) MD 31 [ ] Angle adjustable and foldable back (Only in combination with push bar height adjustable SD 06) SD 10 [ ] Pin back adjustment, foldable (Not in combination with with MD 31) Back Systems MD 32 [ ] Backster (only for seat width 15" / 375 mm till 20" / 500 mm) MD 37 [ ] The Back 2 (only for seat width 16" / 400 mm till 22" / 550 mm) MD 38 [ ] The Back 3 (only for seat width 16" / 400 mm till 22" / 550 mm) MD 39 [ ] The Back 4 (only for seat width 16" / 400 mm till 22" / 550 mm) Accessories Back Systems MD 33 [ ] Fixed lateral support large, left side MD 37 [ ] Fixed lateral support large, right side MD 34 [ ] Fixed lateral support small,left side MD 38 [ ] Fixed lateral support small, right side MD 35 [ ] Swing-away lateral support, left MD 39 [ ] Swing-away lateral support, right MD 36 [ ] Lateral/lumbar pad set Front rigging SB 01 [ ] Without front rigging SB 02 [ ] Pair (is needed for footrests SB 10, SB 11, SB 14, MB 25 and MB 15) SB 03 [ ] Center mounted footplate 75 (front rigging is not needed) SB 12 [ ] One piece footplate 90, folding upwards (front rigging is not needed) discovery tmax 3/7
4 Footrests SB 10 [ ] Single footplates, pair (composite) SB 11 [ ] Single footplates, pair (aluminum) SB 14 [ ] Single footplates for lower leg length (only tmax kids) MB 25 [ ] Elevating legrest plastic, pair (not in combination with tmax Kids) MB 15 [ ] Elevating legrest metal, pair (not in combination with tmax Kids) Footrest options SB 20 [ ] Leg strap SB 21 [ ] Heel loop pair Frame options SA 01 [ ] Rear anti-tip right SA 02 [ ] Rear anti-tip left SA 03 [ ] Tip assist right SA 04 [ ] Tip assist left Armrest SE 01 [ ] Without armrest SE 02 [ ] Armrest fixed height (pair) SE 03 [ ] Armrest height adjustable (pair) Armpad SE 20 [ ] Armpad short (pair) SE 21 [ ] Armpad long (pair) SE 22 [ ] Without armpad More arm positioning systems see order form wheelchair accessories I 647F346 Accessories Armrest add charge ME 60 [ ] Tray (only in combination with armpads) Side guard SE 10 [ ] Without side guard SE 11 [ ] Side guard for armrest (pair) Transit Option SK 01 [ ] Without transit option SK 02 [ ] 4 transport brackets and wheelchair anchor for pelvic belt (tested according ISO and ANSII RESNA WC 19) Frame colours 010 [ ] Dormant marine blue 021 [ ] Sparkle granny smith/metallic green 013 [ ] Deep black 038 [ ] Sparkle red 016 [ ] Silver metallic 019 [ ] White pearl (only for tmax adult) 036 [ ] Purple (only for tmax kids) 037 [ ] Pink (only for tmax kids) Front casters SF 01 [ ] 6" pneumatic SF 02 [ ] 6" solid PU SF 03 [ ] 7" pneumatic SF 04 [ ] 7" solid PU discovery tmax 4/7
5 SF 05 [ ] 8" pneumatic SF 06 [ ] 8" solid PU Rear wheel options SG 01 [ ] 12 1/2" composite wheel SG 02 [ ] 16" composite wheel SG 03 [ ] 22" quick release SG 04 [ ] 24" quick release Rear Tire options SG 10 [ ] Pneumatic SG 11 [ ] Solid PU Wheel lock options SH 01 [ ] Push to lock wheel locks (pair) SH 05 [ ] Wheel lock extension SH 07 [ ] Attendant Hublock cane mount (not for 16") discovery tmax 5/7
6 Seat height, please choose pre setup: Seat height tmax Kids 12 1/2" 16" Rear wheel size 22" 24" Seat height, please choose pre setup: Seat height tmax adult 12 1/2" 16" Rear wheel size 22" 24" Front caster size 6" 7" 8" [ ] 325 mm (13") [ ] 325 mm (13") [ ] 325 (13") [ ] 475 mm (19") [ ] 500 mm (20") Front caster size [ ] 390 mm (15,5") [ ] 420 mm (16,5") [ ] 445 mm (17,5") [ ] 470 mm (18,5") [ ] 495 mm (19,5") [ ] 475 mm (19") [ ] 500 mm (20") [ ] 475 mm (19") [ ] 500 mm (20") 6" 7" 8" [ ] 420 (16,5") [ ] 445 (17,5") [ ] 470 (18,5") [ ] 495 (19,5") discovery tmax 6/7
7 Technical data Technical data Size 1 (tmax Kids) Size 2 (tmax Adult) Size 3 (tmax Adult) Size 4 (tmax Adult) Frame width (FW) with 12" wheels SW +6" (15 cm) SW +6" (15 cm) SW +6" (15 cm) SW +6" (15 cm) Seat width between armrest (SW) 12-16" (30-40 cm) 14-18" (35-45 cm) 16-20" (40-50 cm) 18-22" (45-55 cm) Seat width at outside seat rails 11-15" (~28-38 cm) 13-17" (~33-43 cm) 15-19" (~38-48 cm) 17-21" (~43-53 cm) Seat depth (SD) 12-16" (30-40 cm) 12-19" (37,5-47,5 cm) 15-22" (37,5-55 cm) 15-22" (37,5-55 cm) Rear wheels 12"/16"/22"/24" 12"/16"/22"/24" 12"/16"/22"/24" 12"/16"/22"/24" Seat height (SH) 13-18" (35-45 cm) 14-20" (ca cm) 14-20" (ca cm) 14-20" (ca cm) Tilt in space Height back canes from seat plate Back rest inclination Frame length with 12 1/2" wheels (without footrest and anti tipper) from ca. 21" from ~53 cm from ca. 24" from ~61 cm from ca. 27" from ~68,5 cm from ca. 27" from ~68,5 cm Max. load incl. seat unit 90 kg/200 lbs 136 kg/300 lbs 136 kg/300 lbs 136 kg/300 lbs Frame weight (without seat, footrest, armrest, rear wheels) 15 kg/33 lbs 16 kg/35 lbs 16,5 kg/36 lbs 17 kg/37,5 lbs Front casters 6"/7"/8" 6"/7"/8" 6"/7"/8" 6"/7"/8" discovery tmax 7/7
discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed
BITTE DETACH HIER HERE ABTRENNEN AND SEND UND BY ZU FAX OTTO TO OTTO BOCK BOCK FAXEN Base price: EUR x,xxx All prices in EUR, valid from 01/01/2012 to 31/12/2012 Order no.: discovery tmax Article number:
Order no.: ... Date Signature. Posterior seat height
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P.O. number:* Company Name:* Ordered by:* 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com Date: Phone:* 4.7 Ship to:*
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Power Wheelchair Retail Prescription Form KITEMAX210917 Tel: 01656 776222 Fax: 01656 776220 OCTOBER 2017 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Account No : Contact
Mygo Seat Spare Parts Catalogue
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Kimba. T h e K i m b a F a m i l y o f P e d i a t r i c M o b i l i t y P r o d u c t s
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4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by: Marked for: User manual: PO: Postal Code: Phone:
519, J-Oswald Forest, suite 101 Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 www.motioncomposites.com Account: Vendor: Date: Ordered by: Email: Marked for: User
Transport Chairs / Walkers MRI Transport
MRI Folding Walkers 18 Wide, Depth 17 250 lb weight capacity WA-1000 Adult - 32 to 36 $195.00 ea. WA-1001 Junior - 28 to 32 $195.00 ea. MRI Heavy Duty / Extra Wide Folding Walker 24 Wide, Depth 21 500
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PARTS CATALOG CONTENTS SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT... SIDEFRAME (DETACHABLE ARM), CROSSBRACE... ARM, DETACHABLE...5 CASTER...5 UPHOLSTERY (ALL SIDEFRAMES)...6 FRONT RIGGING, DETACHABLE...6
For the Modulite Teen seating please select the underlined options on this form and include a completed Modulite Teen Seating form
Power Wheelchair Retail Prescription Form BORAMOD111217 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2018 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Customer Ref : Account
q q q q q q q q q q q q q q q q q q Frame q Titanium Frame K5-CAT5-TITAN $ Includes hangers and base frame. Does not include Cross Braces.
Funder: Order Number: Date: q Quote q PO Number: Therapist: Marked For: Catalyst 5 K5-CAT5-ALI 136kg weight capacity Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth
Assembly Product name Item no. Version
MANUAL WHEELCHAIRS 1 Sideguard 1 2 6 3 4 7 8 9 1 1 470019 Sideguard left, complete pc. 2 1 470018 Sideguard right, complete pc. 3 1 420013 Sideskirt black, left pc. 4 1 420012 Sideskirt black, right pc.
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Invacare Ltd Power Prescription Form Pencoed Technology Park Dealer Prescription Form Pencoed CF35 5AQ LPF1U2KITEFLEX011015Dealer Tel: +44 (0) 1656 776222 Fax: +44 (0) 1656 776220 July 2015 email: ordersuk@invacare.com
Bora. Standard Base Price 4,100. Standard Features SEAT DEPTHS
Power Wheelchair Retail Prescription Form BORAMOD121218 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Customer Ref : Account
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RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"
Manual Wheelchair Retail Prescription Form ACTION515112017 Tel: 01656 776222 Fax: 01656 776220 JAN 2018 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer Ref: Contact
wheelchairs aspire for... mobility comfort style LITE TRANSIT RANGE Aspire EVOKE Aspire EVOKE HD
EVOKE & EVOKE HD TRANSIT ASSIST wheelchairs aspire for... mobility comfort style LITE LITE TRANSIT RELAX RANGE Aspire EVOKE Aspire EVOKE HD Aspire ASSIST Aspire TRANSIT Aspire RELAX Aspire LITE Aspire
Invacare Kite (Max Seating System) Retail Max User Weight 160Kg (25 stone)
Power Wheelchair Retail Prescription Form KITEMAX160718 Tel: 01656 776222 Fax: 01656 776220 JULY 2018 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Account No : Contact No
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R82 x:panda. USD Retail Price List/ Order Form. Account #: Purchase Order No.:
Account #: Purchase Order No.: Contact: R82 x:panda USD Retail Price List/ Order Form Date: Mark For: Bill To: Address: City/State/Zip: Phone: Email Ship To: Address: City/State/Zip: Phone: US Configuration
SHIPPING INFORMATION Provider Acct #:
May 2014 Kids ROCK TM Size 2 Order Form Maximum Weight Capacity 115 lbs. 14"Wx16"Dx22"H Seating Capacity. Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
Sling Position. Push Handle. q Omit Push Handles N/C q Standard Push Handles 53 q Fold Down Push Handles 80 q Bolt-On Push Handles 109
Effective 05/07/2014 Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: q Rogue XP 1825 Rogue Width Grow-able Frame. 275 lb weight capacity. Maximum initial : 16. q Rogue 1495 Rogue Standard
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4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required MVMA053 MVMA056. MVMA058 English Manual (STD) Dutch Manual
160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 orders@motioncomposites.com www.motioncomposites.com 4.8 MOVE ORDER FORM - INTERNATIONAL P.O.
WHEELCHAIRS. aspire for... mobility comfort style OUR RANGE The Aspire EVOKE.
EVOKE ASSIST WHEELCHAIRS aspire for... mobility comfort style LITE TRANSIT RELAX OUR RANGE The Aspire EVOKE The Aspire ASSIST The Aspire TRANSIT The Aspire RELAX The Aspire LITE www.aspirewheelchairs.com.au
4.2. Ship to: Vendor: Name: Date: Address: Ordered by: City: Province:
519, J-Oswald Forest, suite 101 Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 orders@motioncomposites.com www.motioncomposites.com 4.2 Helio C2 ORDER FORM - CANADA
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4.8. A6MA085 Italian Manual. 3" caster 4" caster. 8" caster Stem bolt Length. + 2,54 cm 1" + 5,08cm 2" STD. 36,8cm 14,5" 34,3cm 13,5" 39,4cm 15,5"
160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio A6 ORDER FORM - INTERNATIONAL P.O.
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4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required KDMA063 English Manual (STD) Manuel Français
160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 P.O. number:* Date: Ship to:* Company Name:*
MASS Script Form. Frame. Backrest. Seat Depth. Tsunami ALX K0005 Charge. Sling Position. Seat Width / Seat Depth. Seat Width.
MASS Script Form Company: Account Number: Date: Quote PO Number: RTS: Marked For: Australian Order Form Effective 05/07/2014 Ship To: Address: City: State: Zip: Phone: Email/Fax: Tsunami ALX K0005 Charge
Standard Base Price: 618
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
SHIPPING INFORMATION Provider Acct #:
May 2014 Kid's ROCK TM Size 3 Order Form Maximum Weight Capacity 215 lbs. 17Wx20Dx26H Seating Capacity Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
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Aquatec Ocean Family Flexible, modular shower chair commode solutions A range of high quality, modular, stainless steel shower chair commodes that are designed to support a wide range of clients and conditions.
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Account No: Drop Ship/Ship To: Date: Name: P.O. #: Address: Buyer: City: State: Marked For: Zip Code: Phone Number: Seat Depth (Continued) 163SD10 17" NC 163SD11 18" NC 163SD12 19" 1 NC Frame Style 163SD13
MALTE Posterior Walking Aid
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Aquatec Ocean Family. Ocean Family. Aquatec
The Ocean series of shower commode chairs offers a flexible, modular solution for a wide range of clients. The range consists of transit, self-propel, tilt in space as well as powered tilt and recline