Invoice address: same as company address. Invoice address: other (see below) Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact:

Transcription

1 Im Hofstätt 11 D Dotternhausen Tel +49 (0) Fax +49 (0) Quotation date: Order date: according to GTC PRO ACTIV GmbH Speedy F1 oversized rigid frame sports wheelchair Individual customised frame geometry,welded chassis Approved up to 120 kg user load capacity , Medical suppliers / Company address: Cust. no.: Phone: Fax: Contact: Invoice address: same as company address Invoice address: other (see below) Cust. no.: Phone: Fax: Contact: Shipping address:same as company address other (see below) Speedy F1 basket Speedy F1 dance Customer name / commission: Phone: Fax: Date of birth: Paying organisation: Indication: Speedy F1 tennis Speedy F1 badminton / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required

2 Basic size Body size: Body Körpergröße: size: Weight: Gewicht: cm cm kg kg Lower Unterschenkellänge: leg length: cm cm (anatomic (anatomisches dimension: Maß: Kniekehle hollow of the bis Fußsohle) knee to the foot sole) Individual frame geometry oversized: Wheel chair dimensions: A: SB seat width I: Frame length to the front frame bend B: ST seat depth J: KW knee angle or J1: Angle of the front C: RH back height Frame tube to the vertical position D: USL lower leg length M: Lower leg width top E: SHh seat height back N: Lower leg width bottom F: SHv seat height front O: Position of the tip support bearing block (according to the rules in basketball, the rear wheel forms the back-most point) G: KP tipping point (inner edge rear tube to axis middle drive wheel) P: Position of the steering wheel bearing block (distance from the inner edge backrest to middle bearing block) H: Start frame retraction Q: Distance between steering wheel bearing blocks Dimensional tolerances according to DIN EN ISO apply for the design (mm) Degree of accuracy Up to 30 More then 30 to 120 More then 120 to 400 More then 400 to 1000 C +/- 1 +/- 3 +/- 4 +/ / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required

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 Backrest Aluminium side guard, contour following the wheel Bolted backrest, cannot be folded Adapted to the upper edge of the tyre, in frame colour Aluminium side guard, contour by indicated dimension Bolted backrest, cannot be folded Indicated dimension: A= cm / B= cm Welded side guard with alu plate, contour following the wheel Bolted backrest, cannot be folded, Adapted to the upper edge of the tyre, in frame colour (3 cm above the tyre) Welded side guard with alu plate, contour by indicated dimension Bolted backrest, cannot be folded, Adapted to the upper edge of the tyre, in frame colour Indicated dimension: A= cm / B= cm Folding backrest and 7-way angle adjustment, with integrated aluminium side parts Back equipment Adaptable back with back padding Colour: black (Equipment with back bar extended by 120 mm) Open belt system Seat cushion "Standard" seat cushion F1 Höhe: 3cm Höhe: 4cm Höhe: 6cm Cover: black breathable Further seat cushions e.g. "Anti- Decubitus" see separate dimension sheet:"pro ACTIV Seat and back systems" Wheel camber * Total width with tight-mounted hand rim 12 drive wheel camber drive wheel camber drive wheel camber drive wheel camber Footrest Continuous footrest with tubular resting bracket height adjustable +/- 3 cm Continuous footrest with rubber coated footplate Further back systems e.g. ergonomic back shell see separate dimension sheet: "PRO ACTIV seat and back systems" Seat upholstery Body Contour height adjustable +/- 3 cm edge-folded at front, bolted Depth: 27cm Continuous footrest with footplate "Box-Form" height adjustable +/- 3 cm rubber coated Width: 20cm, Length: 31.5cm + 1.5cm adjustable / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required

5 Ram bar Offence bar with radius tube Offence bar with trapezium tube Defence bar, removable Rear protection bar with bent tube Adaptations Central anti-tipping support oversized, welded (basket ball) with screwed axle with quickrelease axle anti-tipping supports with oversized tube with screwed axle with quickrelease axle Central anti-tipping support with oversized tube, length adjustable (Tennis) fixed tipping wheel rotary fork Mittelkippstütze abnehmbar 4 Dance über Schnellspannklammer, mit drehbarer Lenkradgabel und Skaterolle Ø80mm in Bodenfreiheit und Winkel einstellbar Farbe: schwarz Caster wheels All caster wheels (except pneumatic tyres) are puncture-proof! 3" Skate wheel (80 mm) puncture-proof Drive wheels 24" drive wheel, 36 spoke aluminium rim with aluminium front hub, radially spoked (ETRTO 540) Drive wheel double rim 36 spokes 24" (ETRTO 540) " (ETRTO 559) " (ETRTO 590) " (ETRTO 622) 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 24 (ETRTO 540) (ETRTO 559) (ETRTO 590) Handrims x = dimension handrim attachment! Handrim attachment: x = 11mm x = 19mm If no specification is given, the handrims will be mounted wide (19mm/18mm). Ø 19 mm stainless steel handrims for 28" wheel Ø 19 mm aluminium handrims silver anodised Ø 19 mm aluminium handrims polished and hard-anodised / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required

6 Ø 19 mm titanium handrims Silicone handrim cover for 24" hand rim for 26" hand rim Surface without structure compatible with handrim Ø 19mm or Ø 20mm. Spoke guard Finger- and spoke guard "transparent" for 24" wheel basket silly-bubble 28x1" high pressure smooth running 7.5 bar (ETRTO 622) Schwalbe "SpeedAir" Indoor sports tyre 10 bar 24x3/4 (540-20) x3/4 (559-20) x3/4 (590-20) Colour: white, black wall Accessories Hand air compressor with pressure gauge up to 14 bar Transport bag for drive wheels for 24" wheel Ø76cmx2cm Ø83cmx2cm Your additional notes: blue-sky colour-stones Tyres Schwalbe "RightRun" High-pressure tyre 7.5 bar 24x1 (540-25) x1 (559-25) x1 (590-25) 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 required