Quickie Q7 Adjustable December 2012

Transcription

1 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Quickie Q7 Adjustable December 2012 ZIP: Ship T: Attentin: Address: Address: Cnfirmatin Ship T City: ST: Cnfirm Via: Fax Ship T Phne: ( ) Fax: ( ) EIR4 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 Price Optin # HCPCS Definitin 1. FRAME STYLE & SETUP PO#: ADDITIONAL SHIPPING INFORMATION ZIP: Price 186WM60 Base Mdel Quickie Q7 - Adjustable (265 lbs) K0005 Pwer assist NA n the Q7 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 $ 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 $ Frame Angle See FIGURE 1 Measure frm frnt frame t flr. 186FA1 186FA8 186FA Figure 1 Figure 2 $2, See FIGURE 2 Frame Inset is the distance frm the utside f the seat tube t the utside f the ftrest. 186FF1 186FF2 0" 1" (NA w/ 12" wide) 186FF3 2" (NA with 12" & 13" wide) 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 Frame Inset Per Side Caster Husing Psitin Setting 1 Suggested fr 3" & 4" casters. Fr 2" Inset all casters use Setting 2 Setting 2 Suggested fr 5" & 6" casters. Setting 3 NA w/ 6" casters Same as current GT caster placement Frame - Direct Munt Wheel Lck (Optinal) 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. NA with rear suspensin system. 186WH13 Direct Munt Wheel Lck Figure 3 Figure 4 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 1

2 1. FRAME STYLE & SETUP (CONT.) Depth Adjustable Backrest (Optinal) See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. 0 Setting Backrest at standard 186DP02 $ psitin, field adjustable t -1" r -2" 186DP03 186DP04-1 Setting Backrest -1" ffset, field adjustable t flush r -2" -2 Setting Backrest -2" ffset, field adjustable t flush r -1" $ $ Figure 6 Figure 7 See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 12" 186S8 17" JAY Cushins (Optinal) 186S4 13" 186S9 18" T rder any JAY cushins n-chair, please see the JAY price list. 186S5 14" 186S10 19" Cushin name r part number must be filled ut with desired width and depth 186S6 15" 20" JAY Bundled Cushin 186S48 $ S7 16" (E2201) 186JC20 Cushin Name r Part # Price List Width: Depth: Seat Depth Figure 5 Seat Width 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 12" 186SD10 17" 186SD6 13" 186SD11 18" 186SD7 14" 186SD12 19" 186SD8 15" 20" 186SD13 186SD9 16" (E2203) $ OP01 186OP02 186OP04 2. FRONT SEAT HEIGHT SET UP Seating Systems Standard Seat Sling Ultra Seat Sling Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. Omit Seat Sling $ 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 Caster Wheels 186CW1 3" Micr 186CW3 4" Lw Prfile Plyurethane 186CW31 4" Micr Lighted $ CW72 4" x 1" Aluminum Ply $ CW44 4" x 1.25 Semi Pneumatic $ CW64 4" x 1.5" Aluminum Sft Rll $ CW5 5" Lw Prfile Plyurethane 186CW51 5" Micr Lighted 186CW6 5" Sft Rll (Grey) -NA w/frg Legs 186CW65 5" x 1" Aluminum Ply $ CW7 5" x 1.5" Semi Pneumatic 186CW66 5" x 1.5" Aluminum Sft Rll $ CW34 6" Ply 186CW33 E2214 E2215 6" Pneumatic $ CW35 6" x 1.5" Semi Pneumatic 186CW68 6" x 1.5" Aluminum Sft Rll $ Caster Frks and Suspensin 186CF65 Multiple Psitin 186CF69 Multiple Psitin Single Sided Frk 186CF53 E1015 Frg Legs 0 weight t 100 lbs. $ CF54 E1015 Frg Legs 101 lbs. weight t 190 lbs. $ CF55 E1015 Frg Legs 191 lbs. weight t 265 lbs. $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 2

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 Ultra Lite Platfrm Ftrest 186F111 K0040 NA w/ 14" wide and 2" inset, NA w/ $ wide w/ 0" inset Adaptive Platfrm Spacer Only available with Platfrm Ftrest. NA w/ Ultra Lite Platfrm. 186AD1 186AD2 186AD3 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer Ftrest Optins 186DI08 K0037 High Munt Ext Tubes (NA w/ Tubular ftrest) $ DI03 K0038 Leg Strap $ DI04 K0038 Extra Leg Strap $ DI05 Gel Hanger Cver $ DI07 Neprene Impact Guards 186DI02 Wear Pads $ DI06 Psitin Plates (NA fr Tubular Ftrest) $ BACKREST Back Type 186BT96 Flding Angle Adj w/duble Lck Dwn 186BT3 Nn-Flding Angle Adjustable Chse Optin 1 r 2 1. Aluminum Height Adjustable Backrest 2. Ultra Lightweight Aluminum Fixed Backrest 186B B B B110 Setting Setting Setting Setting 10 "- 14" Back Height Select back height. 8", 9", r 10" nly available mit push handles ", 18", r 19" nly available with fld dwn push handles 12 "- 16" Back Height 186BB21 8" $ BB17 14" $ BB20 9" $ BB18 15" $ "- 18" Back Height 186BB13 10" $ BB19 16" $ BB14 11" $ BB10 17" $ "- 20" Back Height 186BB15 12" $ BB11 18" $ BB16 13" $ BB12 19" $75.00 OR Twel Bar 186QT01 Standard Style - 4" Offset 186QT02 Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with 19" & 20" wide $50.00 Backrest Handles 186PH6 Integral Push Handles Fld Dwn Push Handles NA w/ 10"- 186PH5 14" adj height & 8"-10" fixed height $ NA w/ standard uphlstery 186PH2 Omit Push Handles Backrest Uphlstery 186BU1 Standard Uphlstery 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $ BU71 E2611 Backrest Tensin Adj 3DX Vented $ BU14 Omit Back Uphlstery -$ JB01 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 Military Service Patches Only available n tensin adjustable uphlstery and Jay 3 Back 186VU1 186VU2 US Marines Patch US Army Patch $90.00 $ VU3 US Navy Patch $ VU4 US Air Frce Patch $ VU12 Cast Guard Patch $ VU5 Purple Heart $ VU8 Purple Heart with Marines Patch $ VU9 Purple Heart with Army Patch $ VU10 Purple Heart with Navy Patch $ VU11 Purple Heart with Air Frce Patch $ VU13 Purple Heart with Cast Guard $ OD5 186A192 Backrest Optins Narrw Backrest Inset Backcanes 1" narrwer than selected seat width. NA with 12" Wide. NA w/ Aluminum r Carbn Side Guards Telescping Push Handles Range f 13-19" frm sling t handle $80.00 $ REAR SEAT HEIGHT SET UP Axle Plate Adjustable COG (1"-4") Rear Suspensin (Optinal) 4-Link Rear Suspensin COG (0"-3") 2" COG. Plastic Side Guards nly available up t 2.5" COG 186SV08 186SV09 Weight frm 0 lbs t 175 lbs Weight frm 176 lbs. t 265 lbs Single Pst nly available up t $ $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 3

4 5. REAR SEAT HEIGHT SET UP (CONT) Center f Gravity Preset Measure frm frnt f back pst t the center f rear axle. 186CC12 0" (Rear Suspensin System Only) 186CC1.5" (Rear Suspensin System Only 186CC2 1.0" 186CC3 1.5" 186CC4 2.0" 186CC5 2.5" 186CC6 3.0" 186CC7 3.5" (NA w/ Suspensin) 186CC8 4.0" (NA w/ Suspensin) Camber 186CI CI CI4 6 (NA w/ Mag wheel) 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 3.5" Max Frnt t Rear Seat Hgt. 17", 18" Seat Depth 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. NA w/ Rear Suspensin 186RH " Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 186RH " Only w/ 20" Rear Wheel. 186RH " Only w/ 20" Rear Wheel. 15.0" Only w/ 20" r 22" Rear 186RH15 Wheel fr Adjustable Axle. Only w/ 20" Rear Wheel fr Rear Suspensin 15.5" Only w/ 20" r 22" r 24" 186RH16 w/hp Clincher Rear Wheel. Only w/ 20" Rear Wheel fr Rear Suspensin 186RH " NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 186RH " NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " NA w/ Rear Suspensin Wheel Ultra Mag Lite Spke Tire Lightweight Spinergy Full Ply Tire 20,22,24 20,22,24 High Pressure Clincher 22,24,25,26 22,24,25 22,24,25,26 Kik Mak Black 24 24,25 24,25 Knbby V-TRAK Pneumatic 20,22,24 20,22,24,26 22,24,26 Pneumatic w/airless Insert 20,22,24 20,22,24,26 22,24,26 Schwalbe Marathn 24 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" = " = 590 Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Pwer assist nt available n the Q7. Cntact Built 4 Me fr Spinergy clr ptins. 186RW3 20" Mag 186RW8 22" Mag 186RW1 24" Mag 186RW90 20" Lite Spke $ RW91 22" Lite Spke $ RW92 24" Lite Spke 186RW93 25" Lite Spke 186RW94 26" Lite Spke $ RW06 22" Ultra Lightweight Spke 2.0 $ RW10 24" Ultra Lightweight Spke 2.0 $ RW16 25" Ultra Lightweight Spke 2.0 $ RW28 22" Spinergy SPOX Black Spkes $ RW95 24" Spinergy SPOX Black Spkes $ RW96 25" Spinergy SPOX Black Spkes $ RW97 26" Spinergy SPOX Black Spkes $ RW32 22" Spinergy LX Black Spkes $ RW98 24" Spinergy LX Black Spkes $ RW99 25" Spinergy LX Black Spkes $ RW40 26" Spinergy LX Black Spkes $ RW50 24" Muntain $ AX1 186AX13 Axle Quick Release Steel Quad Quick Release Steel Only available with Mag Wheels Handrim Natural Fit Handrims nly available in 22", 24", & 25" 186HR1 186HR4 Aluminum Andized Plastic Cated NA 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 NA w/ Ultra Lightweight Wheels $90.00 Rear Wheel Tire 186RT3 E2218 Full Ply Tire 186RT6 High-Pressure Clincher 186RT22 E2218 Kik Mak Black 186RT27 Knbby V-TRAK by Kenda 186RT12 Muntain Only available in 24" 186RT1 Pneumatic 186RT2 186RT21 186RT28 E2213 Pneumatic Airless Insert $80.00 Schwalbe Marathn Plus Evlutin Schwalbe Speed Run Tire Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 4

5 5. ARMREST Armrest - Padded Swing Away Sme limitatins when used with the Angle Adjustable Back in the rear mst setting Please select a setting, will default t 11" if n selectin is made 186AA18 E0973 Padded Swing-Away STD (9" t 14") $ Setting 9" 10" 11" 12" 13" 14" 186AM23 186AM21 186AM24 186AM22 Armpad - Fr Height Adjustable Desk Length (10") Classic Desk Length (10") Cntur Full Length (14") Classic Full Length (14") Cntur 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 $ $ NP01 Armrest Optins Gel Swing Away Pad $ 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) Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 186GE02 186GE03 Black Matching Frame- Standard Clrs Matching Frame- Custm Clr $ WL12 186AT37 E0971 Wheel Lck Optins D Nt Munt Anti Tips Anti Tips (Pair) Side Guards Increases verall width f chair. Sme interferance my exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard NA w/ Height Adjustable Arms 186SG29 K0108 Plastic Lw NA w/ Height Adjustable Arms 186SG35 186SG36 K0108 K0108 Aluminum NA w/height Adj. Arms, High Push r Pull Wheel Lcks Aluminum w/ Fender NA w/ Height Adj. $ $ Arms, High Push r Pull Wheel Lcks 186SG12 K0108 Carbn Fiber NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks $ Psitining Belt 186A117 E0978 Belt 2" Aircraft Buckle w/clamps $ A118 E0978 Belt 2" Aircraft Buckle Padded w/clamps $ A141 E0978 Belt 1.5" Aut Buckle Universal w/clamps $70.00 Additinal Pack Accessries 186A1 Backpack - Adult $ A2 Backpack - Kids $ A8 Black Seat Puch $45.00 $60.00 $ Spke Guards 186A23 K0065 Black Spke Guard $ A302 K0065 Quickie "Q" Clear $ A A83 Miscellaneus E2207 Crutch Hlder Tl Kit $ $45.00 Frame Clr 186C118 Bead Blast 186C2 Black 186C10 Black Opal 186C38 Blue Opal 186C36 Candy Blue 186C14 Candy Purple 186C35 Candy Red 186C128 Cpper 186C6 Frest Green 186C127 Fuchsia 186C126 Glw 186C116 Matte Black 186C117 Matte Green 186C4 Midnight Purple 186C5 Pearl Pink 186C103 Rtbeer 186C114 Sparkle Silver 186C113 Titanium Clr Paint 186C11 Txic Green 186C8 Yellw Custm Frame Clr 186C112 Desert Camuflage $ C43 Mssy Oak Camuflage $ C42 Stars & Stripes $ C108 Zebra (Chse abve base clr) Std with White unless abve base paint is chsen NA w/ Black $ Andized Clr Package Frks, Backcane Bracket, Rear Axle Clamp. NA w/ Frg Legs- andized parts can be rdered separately 186EB07 186EB08 Black Blue $ EB09 Green $ EB10 Purple $ EB11 Red $ EB12 Ti Grey $ Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3, Fax: (800) Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 5

6 7. APPENDIX BASE CHAIR WEIGHTS DEPTH WIDTH **Weights are prvided as a guideline, actual can vary because f sizing, manufacturing, r material variances. Example 20" tire vs. 24". **Nt all frame set up r ptins are listed Base Chair Includes: Frnt Caster 4" Lw Prfile Ply Frk Lw Narrw Caster Blt Caster Stem Shrt (1.75") Ft Rest Aluminum Tubular Rear Wheel 24" Lite Spke Wheel Tire Pneumatic Handrim Aluminum Andized Backrest Shrt 2" Twel Bar Backrest UPH Standard Seat Sling Standard Pushhandles Omit Push Handle 12"-16" Wheel Lck Erg Scissr Cmpnent lbs Cmpnent lbs Cmpnent lbs Cmpnent lbs Seat Sling DAB Rear Tires (Pair) Wheel Lck (Pair) Standard Seat Sling 0.00 With Padded S/A Armrest 1.20 Full Ply 0.70 Push Wheel Lck 0.16 Ultra Seat Sling With Out Padded S/A Armrest 0.66 High-Pressure Clincher Pull Wheel Lck 0.16 Omit Seat Sling Backrest with Twel Bar Kik Mak Black 1.12 Erg Scissr 0.00 Seat Cushin 4" Tw el Bar 0.04 Knbby V-Trak by Kenda 0.89 Cmpact Wheel Lck " Cushin 1.26 Adj Height BackRest 10-14,12-16, Muntain Tire 1.54 Grade Aid Hardw are Omit Cushin 0.00 Adj Height BackRest Pneumatic 0.00 Direct Munt Caster Wheels (Pair) 8" Fixed Height Backrest Pneumatic Airless Insert 2.00 Omit Wheel Lck " Micr " Fixed Height Backrest Schw albe Marathn Plus Evlutin 0.34 Wheel Lck Extensin Handle 4" Lw Prfile Ply " Fixed Height Backrest Schw albe Speed Run " Pair " Micr Lighted " Fixed Height Backrest Handrims (Pair) Rear Anti-tip 4" x 1" Aluminum Ply " Fixed Height Backrest Aluminum Andized 0.00 Anti-tip 24" Wheel " x 1.25" Semi Pneu " Fixed Height Backrest Aluminum - Ultra Wheel Only Omit Anti-Tips x 1.5" Aluminum Sft Rll " Fixed Height Backrest Plastic Cated 1.60 Side Guard 5" Lw Prfile Ply " Fixed Height Backrest 0.01 Natural Fit Standard Grip 1.95 Plastic Side Guard Lw " Micr Lighted " Fixed Height Backrest 0.04 Natural Fit Super Grip 1.95 Plastic Side Guard Standard " Sft Rll Semi Pneu " Fixed Height Backrest 0.06 Natural Fit LT Standard Grip 1.57 Carbn " x 1" Aluminum Ply " Fixed Height Backrest 0.08 Natrual Fit LT Super Grip 1.57 Aluminum Side Guard " x 1.5" Semi Pneu " Fixed Height Backrest 0.11 Armrests (Pair) Aluminum Side Guard w ith Fender " x 1.5" Aluminum Sft rll 1.04 Active Rigid Backrest 0.23 Padded S/A Assembly 2.97 Accessries 6" Ply 0.67 Backrest UPH SPHA Standard 4.33 Backpack " x 1.5" Semi Pneu 0.88 Tensin Ballistic 0.51 SPHA Lw 3.76 Backpack Kids "x 1.5" Aluminum Sft Rll 1.35 Tensin Vented 0.47 Armrest Pads (Pair) Black Seat Puch " Pneumatic 0.55 Standard 0.00 Desk Length - Classic 2.22 Belt 2" Aircraft Buckle 0.44 Caster Frks (Pair) Omit Uphlstery Desk Length - Cntur 1.14 Belt 2" Aircraft Buckle Padded 0.60 Lw Narrw 0.00 Push Handles (Pair) Full Length - Classic 2.73 Belt 1.5" Aut Buckle Universal 0.38 Lw Wide 0.07 Integral Push Handles Shrt 0.10 Full Length - Cntur 1.50 Crutch Hlder 0.57 Lw Single Sided 0.02 Integral Push Handles Medium 0.17 Rear Wheel (Pair) Gel Cver Armrest Pad 0.48 Standard Narrw 0.04 Integral Push Handles Tall " Mag Wheel 0.82 Neprene Impact Guards 0.11 Standard Wide 0.12 Fld-Dw n Push Handles 12-16, " Mag Wheel 1.32 Wheelchair Tray 6.50 Standard Single Sided 0.09 Fld-Dw n Push Handles " Mag Wheel 1.78 Axles (Pair) Frg Legs 0.62 Omit Push Handle " Lite Spke Wheel Quick Release (Light Spke Wheel) 0.00 Ftrest Omit Push Handle " Lite Spke Wheel Quick Release (Spinergy, Ultra-Light) 0.03 Aluminum Tubular 0.00 Omit Push Handle " Lite Spke Wheel 0.00 Quick Release (Mag Wheels) 0.00 Aluminum Tubular Lng 0.06 Omit Push Handle " Lite Spke Wheel 0.07 Quad Quick Release 0.13 Aluminum Platfrm 1.07 N Push Handles " Lite Spke Wheel 0.27 Suspensin Aluminum Platfrm Lng 1.14 Leg Strap 20" Ultra Lightw eight Spke Wheel Link Suspensin Assembly 2.75 Ultra Lite Aluminum Ftrest 0.36 N Leg Strap " Ultra Lightw eight Spke Wheel Ultra Lite Aluminum Ftrest Lng 0.41 Leg Strap (10-14") " Ultra Lightw eight Spke Wheel Ftrest Optins Leg Strap (15-17") " Ultra Lightw eight Spke Wheel Remvable Snap On Cver (16" Wide) 0.24 Leg Strap (18-20") " Spinergy SPOX Black Wear Pads (ea) Need 2 per chair 0.02 Back Type 25" Spinergy SPOX Black 0.15 Adaptive Platfrm 2" Spacer 0.16 Angle Adj. Flding Lck Dw n Back " Spinergy SPOX Black 0.43 Adaptive Platfrm 4" Spacer 0.34 Nn-Flding Backrest " Spinergy LX Black Adaptive Platfrm 6" Spacer " Muntain (Uses a 22" Rim) 2.97 Psitin Plate fr Aluminum Ftrest 1.04 N Ft Rest Optins 0.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev L Page 6

7 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Quickie Q7 Adjustable January 2013 ZIP: Dealer Phne: ( ) Fax: ( ) Address: Cnfirmatin Ship T City: ST: Cnfirm Via: Fax Ship T Phne: ( ) Fax: ( ) EIR4 PO#: Ship T: Attentin: Address: ADDITIONAL SHIPPING INFORMATION ZIP: a Optin # 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. HCPCS Definitin Price a 1. FRAME STYLE & SETUP Optin # HCPCS Definitin Price Base Mdel Quickie Q7 - Adjustable (265 lbs) Pwer assist NA n the Q7 Frame Angle See FIGURE 1 Measure frm frnt frame t flr. 186FA FA FA WM60 K0005 $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 $ 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 $ Transit 186TO45 Transit $ 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 0" 1" (NA w/ 12" wide) 186FF3 2" (NA with 12" & 13" wide) 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. Caster Husing Psitin See FIGURE 4 186LH01 Setting 1 Suggested fr 3" & 4" casters. Fr 2" Inset all casters use Setting 2 186LH02 Setting 2 Suggested fr 5" & 6" casters. 186LH03 Setting 3 NA w/ 6" casters Frame - Direct Munt Wheel Lck (Optinal) 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. NA with rear suspensin system. 186WH13 Direct Munt Wheel Lck Figure 1 Figure 2 Figure 3 Figure 4 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 1

8 1. FRAME STYLE & SETUP (CONT.) Depth Adjustable Backrest (Optinal) See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. 0 Setting Backrest at standard psitin, 186DP02 $ field adjustable t -1" r -2" 186DP03 186DP04-1 Setting Backrest -1" ffset, field adjustable t flush r -2" -2 Setting Backrest -2" ffset, field adjustable t flush r -1" $ $ Figure 6 Figure 7 See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 12" 186S8 17" JAY Cushins (Optinal) 186S4 13" 186S9 18" T rder any JAY cushins n-chair, please see the JAY price list. 186S5 14" 186S10 19" Cushin name r part number must be filled ut with desired width and depth 186S6 15" 20" JAY Bundled Cushin 186S48 $ S7 16" (E2201) 186JC20 Cushin Name r Part # Price List Width: Depth: Figure 5 Seat Width Seat Depth 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 12" 186SD10 17" 186SD6 13" 186SD11 18" 186SD7 14" 186SD12 19" 186SD8 15" 20" 186SD13 186SD9 16" (E2203) $ OP01 186OP02 186OP04 2. FRONT SEAT HEIGHT SET UP Seating Systems Standard Seat Sling Ultra Seat Sling Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. Omit Seat Sling $ 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 Caster Wheels 186CW1 3" Micr 186CW3 4" Lw Prfile Plyurethane 186CW31 4" Micr Lighted $ CW72 4" x 1" Aluminum Ply $ CW44 4" x 1.25 Semi Pneumatic $ CW64 4" x 1.5" Aluminum Sft Rll $ CW5 5" Lw Prfile Plyurethane 186CW51 5" Micr Lighted 186CW6 5" Sft Rll (Grey) -NA w/frg Legs 186CW65 5" x 1" Aluminum Ply $ CW7 5" x 1.5" Semi Pneumatic 186CW66 5" x 1.5" Aluminum Sft Rll $ CW34 6" Ply 186CW33 E2214 E2215 6" Pneumatic $ CW35 6" x 1.5" Semi Pneumatic 186CW68 6" x 1.5" Aluminum Sft Rll $ Caster Frks and Suspensin 186CF65 Multiple Psitin 186CF69 Multiple Psitin Single Sided Frk 186CF53 E1015 Frg Legs 0 weight t 100 lbs. $ CF54 E1015 Frg Legs 101 lbs. weight t 190 lbs. $ CF55 E1015 Frg Legs 191 lbs. weight t 265 lbs. $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 2

9 3. FOOTPLATE OPTIONS Ftrest 186F229 Aluminum Tubular 186F274 Aluminum Tubular w/ Snap On Cver $ F276 K0040 Angle Adjustable Flip Back $ F51 K0040 Platfrm Ftrest 186F111 K0040 Ultra Lite Platfrm Ftrest NA w/ 14" wide and 2" inset, NA w/ wide w/ 0" inset Adaptive Platfrm Spacer Only available with Platfrm Ftrest. NA w/ Ultra Lite Platfrm. 186AD1 186AD2 186AD3 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer $ Ftrest Optins 186DI08 K0037 High Munt Ext Tubes (NA w/ Tubular ftrest) $ DI03 K0038 Leg Strap $ DI04 K0038 Extra Leg Strap $ DI05 Gel Hanger Cver $ DI07 Neprene Impact Guards 186DI02 Wear Pads $ DI06 Psitin Plates (NA fr Tubular Ftrest) $ BACKREST Back Type 186BT96 Flding Angle Adj w/duble Lck Dwn 186BT3 Nn-Flding Angle Adjustable 186B B B B110 Chse Optin 1 r 2 1. Aluminum Height Adjustable Backrest 2. Ultra Lightweight Aluminum Fixed Backrest 10 "- 14" Back Height Select back height. 8", 9", r 10" nly available mit push handles. Setting ", 18", r 19" nly available with fld dwn push handles 12 "- 16" Back Height 186BB21 8" $ BB17 14" Setting BB20 9" $ BB18 15" 14 "- 18" Back Height 186BB13 10" $ BB19 16" Setting BB14 11" $ BB10 17" 16 "- 20" Back Height 186BB15 12" $ BB11 18" Setting BB16 13" $ BB12 19" $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 Twel Bar 186QT01 Standard Style - 4" Offset 186QT02 186PH6 186PH5 186PH2 Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with 19" & 20" wide Backrest Handles Integral Push Handles Fld Dwn Push Handles NA w/ 10"- 14" adj height & 8"-10" fixed height NA w/ standard uphlstery Omit Push Handles $50.00 $ Backrest Uphlstery 186BU1 Standard Uphlstery 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $ BU71 E2611 Backrest Tensin Adj 3DX Vented $ BU14 Omit Back Uphlstery -$ JB01 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 Military Service Patches Only available n tensin adjustable uphlstery and Jay 3 Back 186VU1 US Marines Patch $ VU2 US Army Patch $ VU3 US Navy Patch $ VU4 US Air Frce Patch $ VU12 Cast Guard Patch $ VU5 Purple Heart $ VU8 Purple Heart with Marines Patch $ VU9 Purple Heart with Army Patch $ VU10 Purple Heart with Navy Patch $ VU11 Purple Heart with Air Frce Patch $ VU13 Purple Heart with Cast Guard $ OD5 186A192 Backrest Optins Narrw Backrest Inset Backcanes 1" narrwer than selected seat width. NA with 12" Wide. NA w/ Aluminum r Carbn Side Guards Telescping Push Handles Range f 13-19" frm sling t handle $80.00 $ REAR SEAT HEIGHT SET UP Axle Plate Adjustable COG (1"-4") Adjustable Extended COG (0"-3") Rear Suspensin (Optinal) 4-Link Rear Suspensin COG (0"-3") Single Pst nly available up t 2" COG. Plastic Side Guards nly available up t 2.5" COG 186SV08 Weight frm 0 lbs t 175 lbs 186SV09 Weight frm 176 lbs. t 265 lbs $ $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 3

10 5. REAR SEAT HEIGHT SET UP (CONT) Center f Gravity Preset Measure frm frnt f back pst t the center f rear axle. 186CC12 0" (Rear Suspensin System Only) 186CC1.5" (Rear Suspensin System Only 186CC2 1.0" 186CC3 1.5" 186CC4 2.0" 186CC5 2.5" 186CC6 3.0" 186CC7 3.5" (NA w/ Suspensin) 186CC8 4.0" (NA w/ Suspensin) Camber 186CI CI CI4 6 (NA w/ Mag wheel) 186RH12 186RH17 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 3.5" Max Frnt t Rear Seat Hgt. 17", 18" Seat Depth 4.0" Max Frnt t Rear Seat Hgt. 19", 20" Seat Depth 4.5" Max Frnt t Rear Seat Hgt. 186RH11 186RH13 186RH14 186RH15 186RH16 Rear Seat Height 13.0" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 13.5" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 14.0" Only w/ 20" Rear Wheel. 14.5" Only w/ 20" Rear Wheel. 15.0" Only w/ 20" r 22" Rear Wheel fr Adjustable Axle. Only w/ 20" Rear Wheel fr Rear Suspensin 15.5" Only w/ 20" r 22" r 24" w/hp Clincher Rear Wheel. Only w/ 20" Rear Wheel fr Rear Suspensin 16.0" NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 186RH " NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 186RH19 186RH26 186RH20 186RH27 186RH21 186RH " 17.5" 18.0" 18.5" 19.0" 19.5" 186RH " NA w/ Rear Suspensin Wheel Ultra Mag Lite Spke Tire Lightweight Spinergy Full Ply Tire 20,22,24 20,22,24 High Pressure Clincher 22,24,25,26 22,24,25 22,24,25,26 Kik Mak Black 24 24,25 24,25 Knbby V-TRAK Pneumatic 20,22,24 20,22,24,26 22,24,26 Pneumatic w/airless Insert 20,22,24 20,22,24,26 22,24,26 Schwalbe Marathn 24 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" = " = AX1 186AX13 Ultra Lightweight nly available w/ Aluminum Handrim. Pwer assist nt available n the Q7. Cntact Built 4 Me fr Spinergy clr ptins. 186RW3 20" Mag 186RW8 22" Mag 186RW1 24" Mag 186RW90 20" Lite Spke $ RW91 22" Lite Spke $ RW92 24" Lite Spke 186RW93 25" Lite Spke 186RW94 26" Lite Spke $ RW06 22" Ultra Lightweight Spke 2.0 $ RW10 24" Ultra Lightweight Spke 2.0 $ RW16 25" Ultra Lightweight Spke 2.0 $ RW28 22" Spinergy SPOX Black Spkes $ RW95 24" Spinergy SPOX Black Spkes $ RW96 25" Spinergy SPOX Black Spkes $ RW97 26" Spinergy SPOX Black Spkes $ RW32 22" Spinergy LX Black Spkes $ RW98 24" Spinergy LX Black Spkes $ RW99 25" Spinergy LX Black Spkes $ RW40 26" Spinergy LX Black Spkes $ RW50 24" Muntain $ Rear Wheel Tire 186RT3 E2218 Full Ply Tire 186RT6 High-Pressure Clincher 186RT22 E2218 Kik Mak Black 186RT27 Knbby V-TRAK by Kenda 186RT12 186RT1 186RT2 186RT21 186RT28 Handrim Natural Fit Handrims nly available in 22", 24", & 25" 186HR1 Aluminum Andized 186HR4 Plastic Cated NA 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 E2213 Axle Quick Release Steel Quad Quick Release Steel Only available with Mag Wheels Rear Wheel Muntain Only available in 24" Pneumatic Airless Insert Schwalbe Speed Run Tire Omit Handrim NA w/ Ultra Lightweight Wheels $90.00 Pneumatic $80.00 Schwalbe Marathn Plus Evlutin Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 4

11 5. ARMREST Armrest - Padded Swing Away Sme limitatins when used with the Angle Adjustable Back in the rear mst setting Please select a setting, will default t 11" if n selectin is made 186AA18 E0973 Padded Swing-Away STD (9" t 14") $ Setting 9" 10" 11" 12" 13" 14" 186AM23 186AM21 186AM24 186AM22 Armpad - Fr Height Adjustable Desk Length (10") Classic Desk Length (10") Cntur Full Length (14") Classic Full Length (14") Cntur Armrest - Height Adjustable 186AA11 E0973 Single Pst Height Adjustable - Std Range 8" - 13". Adjust in 1" increments 186AA29 E0973 Single Pst Height Adjustable - Lw Range 6.5" ". Adjust in 1" increments $ $ NP01 Armrest Optins Gel Swing Away Pad $ 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) Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 186GE02 186GE03 Black Matching Frame- Standard Clrs Matching Frame- Custm Clr $ WL12 186AT37 E SG29 K SG35 K SG36 K SG12 K0108 Wheel Lck Optins D Nt Munt Anti Tips Anti Tips (Pair) Plastic Lw NA w/ Height Adjustable Arms Aluminum NA w/height Adj. Arms, High Push r Pull Wheel Lcks Aluminum w/ Fender NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks Carbn Fiber NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks $60.00 $ Side Guards Increases verall width f chair. Sme interferance my exist w/ padded SA arms at lwest settings Plastic Standard 186SG33 K0108 NA w/ Height Adjustable Arms $ $ $ Psitining Belt 186A117 E0978 Belt 2" Aircraft Buckle w/clamps $ A118 E0978 Belt 2" Aircraft Buckle Padded w/clamps $ A141 E0978 Belt 1.5" Aut Buckle Universal w/clamps $70.00 Spke Guards 186A23 K0065 Black Spke Guard $ A302 K0065 Quickie "Q" Clear $ A1 Additinal Pack Accessries Backpack - Adult $ A2 Backpack - Kids $ A8 Black Seat Puch $ A A83 Frame Clr 186C118 Bead Blast 186C2 Black 186C10 Black Opal 186C38 Blue Opal 186C36 Candy Blue 186C14 Candy Purple 186C35 Candy Red 186C128 Cpper 186C6 Frest Green 186C127 Fuchsia 186C126 Glw 186C116 Matte Black 186C117 Matte Green 186C4 Midnight Purple 186C5 Pearl Pink 186C103 Rtbeer 186C114 Sparkle Silver 186C113 Titanium Clr Paint 186C11 Txic Green 186C8 Yellw Custm Frame Clr 186C112 Desert Camuflage $ C43 Mssy Oak Camuflage $ C42 Stars & Stripes $ Zebra (Chse abve base clr) Std with White unless abve base paint is chsen $ NA w/ Black 186C108 E2207 Miscellaneus Crutch Hlder Tl Kit Andized Clr Package Frks, Backcane Bracket, Rear Axle Clamp. NA w/ Frg Legs- andized parts can be rdered separately 186EB07 186EB08 Black Blue $ EB09 Green $ EB10 Purple $ EB11 Red $ EB12 Ti Grey $ Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3, Fax: (800) $ $45.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 5

12 7. APPENDIX BASE CHAIR WEIGHTS DEPTH WIDTH **Weights are prvided as a guideline, actual can vary because f sizing, manufacturing, r material variances. Example 20" tire vs. 24". **Nt all frame set up r ptins are listed Base Chair Includes: Frnt Caster 4" Lw Prfile Ply Frk Lw Narrw Caster Blt Caster Stem Shrt (1.75") Ft Rest Aluminum Tubular Rear Wheel 24" Lite Spke Wheel Tire Pneumatic Handrim Aluminum Andized Backrest Shrt 2" Twel Bar Backrest UPH Standard Seat Sling Standard Pushhandles Omit Push Handle 12"-16" Wheel Lck Erg Scissr Cmpnent lbs Cmpnent lbs Cmpnent lbs Cmpnent lbs Seat Sling DAB Rear Tires (Pair) Wheel Lck (Pair) Standard Seat Sling 0.00 With Padded S/A Armrest 1.20 Full Ply 0.70 Push Wheel Lck 0.16 Ultra Seat Sling With Out Padded S/A Armrest 0.66 High-Pressure Clincher Pull Wheel Lck 0.16 Omit Seat Sling Backrest with Twel Bar Kik Mak Black 1.12 Erg Scissr 0.00 Seat Cushin 4" Tw el Bar 0.04 Knbby V-Trak by Kenda 0.89 Cmpact Wheel Lck " Cushin 1.26 Adj Height BackRest 10-14,12-16, Muntain Tire 1.54 Grade Aid Hardw are Omit Cushin 0.00 Adj Height BackRest Pneumatic 0.00 Direct Munt Caster Wheels (Pair) 8" Fixed Height Backrest Pneumatic Airless Insert 2.00 Omit Wheel Lck " Micr " Fixed Height Backrest Schw albe Marathn Plus Evlutin 0.34 Wheel Lck Extensin Handle 4" Lw Prfile Ply " Fixed Height Backrest Schw albe Speed Run " Pair " Micr Lighted " Fixed Height Backrest Handrims (Pair) Rear Anti-tip 4" x 1" AluminumPly " Fixed Height Backrest Aluminum Andized 0.00 Anti-tip 24" Wheel " x 1.25" Semi Pneu " Fixed Height Backrest Aluminum - Ultra Wheel Only Omit Anti-Tips x 1.5" AluminumSft Rll " Fixed Height Backrest Plastic Cated 1.60 Side Guard 5" Lw Prfile Ply " Fixed Height Backrest 0.01 Natural Fit Standard Grip 1.95 Plastic Side Guard Lw " Micr Lighted " Fixed Height Backrest 0.04 Natural Fit Super Grip 1.95 Plastic Side Guard Standard " Sft Rll Semi Pneu " Fixed Height Backrest 0.06 Natural Fit LT Standard Grip 1.57 Carbn " x 1" AluminumPly " Fixed Height Backrest 0.08 Natrual Fit LT Super Grip 1.57 AluminumSide Guard " x 1.5" Semi Pneu " Fixed Height Backrest 0.11 Armrests (Pair) AluminumSide Guard w ith Fender " x 1.5" AluminumSft rll 1.04 Active Rigid Backrest 0.23 Padded S/A Assembly 2.97 Accessries 6" Ply 0.67 Backrest UPH SPHA Standard 4.33 Backpack " x 1.5" Semi Pneu 0.88 Tensin Ballistic 0.51 SPHA Lw 3.76 Backpack Kids "x 1.5" Aluminum Sft Rll 1.35 Tensin Vented 0.47 Armrest Pads (Pair) Black Seat Puch " Pneumatic 0.55 Standard 0.00 Desk Length - Classic 2.22 Belt 2" Aircraft Buckle 0.44 Caster Frks (Pair) Omit Uphlstery Desk Length - Cntur 1.14 Belt 2" Aircraft Buckle Padded 0.60 Lw Narrw 0.00 Push Handles (Pair) Full Length - Classic 2.73 Belt 1.5" Aut Buckle Universal 0.38 Lw Wide 0.07 Integral Push Handles Shrt 0.10 Full Length - Cntur 1.50 Crutch Hlder 0.57 Lw Single Sided 0.02 Integral Push Handles Medium 0.17 Rear Wheel (Pair) Gel Cver Armrest Pad 0.48 Standard Narrw 0.04 Integral Push Handles Tall " Mag Wheel 0.82 Neprene Impact Guards 0.11 Standard Wide 0.12 Fld-Dw n Push Handles 12-16, " Mag Wheel 1.32 Wheelchair Tray 6.50 Standard Single Sided 0.09 Fld-Dw n Push Handles " Mag Wheel 1.78 Axles (Pair) Frg Legs 0.62 Omit Push Handle " Lite Spke Wheel Quick Release (Light Spke Wheel) 0.00 Ftrest Omit Push Handle " Lite Spke Wheel Quick Release (Spinergy, Ultra-Light) 0.03 Aluminum Tubular 0.00 Omit Push Handle " Lite Spke Wheel 0.00 Quick Release (Mag Wheels) 0.00 Aluminum Tubular Lng 0.06 Omit Push Handle " Lite Spke Wheel 0.07 Quad Quick Release 0.13 Aluminum Platfrm 1.07 N Push Handles " Lite Spke Wheel 0.27 Suspensin Aluminum PlatfrmLng 1.14 Leg Strap 20" Ultra Lightw eight Spke Wheel Link Suspensin Assembly 2.75 Ultra Lite AluminumFtrest 0.36 N Leg Strap " Ultra Lightw eight Spke Wheel Ultra Lite AluminumFtrest Lng 0.41 Leg Strap (10-14") " Ultra Lightw eight Spke Wheel Ftrest Optins Leg Strap (15-17") " Ultra Lightw eight Spke Wheel Remvable Snap On Cver (16" Wide) 0.24 Leg Strap (18-20") " Spinergy SPOX Black Wear Pads (ea) Need 2 per chair 0.02 Back Type 25" Spinergy SPOX Black 0.15 Adaptive Platfrm2" Spacer 0.16 Angle Adj. Flding Lck Dw n Back " Spinergy SPOX Black 0.43 Adaptive Platfrm4" Spacer 0.34 Nn-Flding Backrest " Spinergy LX Black Adaptive Platfrm6" Spacer " Muntain (Uses a 22" Rim) 2.97 Psitin Plate fr AluminumFtrest 1.04 N Ft Rest Optins 0.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev M Page 6

13 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Cnfirm Via: Quickie Q7 Active Rigid June 2013 ZIP: EIR4 Ship T: Attentin: Address: Address: Ship T City: Fax Ship T Phne: ( ) Fax: ( ) 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 Price Optin # HCPCS 1. FRAME STYLE & SETUP PO#: ADDITIONAL SHIPPING INFORMATION ST: Definitin ZIP: Price 186WM61 Base Mdel Quickie Q7 - Welded (265 lbs) K0005 Pwer assist NA n the Q7 $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 $ 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 $ Frame Angle See FIGURE 1. Measure frm frnt frame t flr. 186FA FA FA2 85 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 0" 1" (NA w/ 12" wide) 186FF3 2" (NA with 12" & 13" wide) 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. Caster Husing Psitin See FIGURE 4 186LH01 Setting 1 Suggested fr 3" & 4" casters. Fr 2" Inset all casters use Setting 2 186LH02 Setting 2 Suggested fr 5" & 6" casters. 186LH03 Setting 3 NA w/ 6" casters Frame - Direct Munt Wheel Lck (Optinal) 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. NA with rear suspensin system. 186WH13 Direct Munt Wheel Lck Figure 1 Figure 2 Figure 3 Figure 4 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid, Rev I Page 1

14 1. FRAME STYLE & SETUP (CONT.) Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 12" 186S8 17" 186S4 13" 186S9 18" 186S5 14" 186S10 19" 186S6 15" 20" 186S48 186S7 16" (E2201) $ Seating Systems 186OP01 Standard Seat Sling 186OP02 186OP04 Ultra Seat Sling Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. Omit Seat Sling $ Seat Depth See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" JAY Cushins (Optinal) shrter than depth rdered, but actual seat depth will remain the same as rdered. T rder any JAY cushins n-chair, please see the JAY price list. 186SD5 12" 186SD10 17" Cushin name r part number must be filled ut with desired width and depth 186SD6 13" 186SD11 18" JAY Bundled Cushin 186SD7 14" 186SD12 19" 186JC20 Cushin Name r Part # Price List 186SD8 15" 20" Width: Depth: 186SD13 $ SD9 16" (E2203) Figure 6 Figure 7 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 Caster Wheels 186CW1 3" Micr 186CW3 4" Lw Prfile Plyurethane 186CW31 4" Micr Lighted $ CW72 4" x 1" Aluminum Ply $ CW44 4" x 1.25 Semi Pneumatic $ CW64 4" x 1.5" Aluminum Sft Rll $ CW5 5" Lw Prfile Plyurethane 186CW51 5" Micr Lighted 186CW6 5" Sft Rll (Grey) -NA w/frg Legs 186CW65 5" x 1" Aluminum Ply $ CW7 5" x 1.5" Semi Pneumatic 186CW66 5" x 1.5" Aluminum Sft Rll $ CW34 6" Ply 186CW33 E2214 E2215 6" Pneumatic $ CW35 6" x 1.5" Semi Pneumatic 186CW68 6" x 1.5" Aluminum Sft Rll $ Caster Frks and Suspensin 186CF65 Multiple Psitin 186CF69 Multiple Psitin Single Sided Frk 186CF53 E1015 Frg Legs 0 weight t 100 lbs. $ CF54 E1015 Frg Legs 101 lbs. weight t 190 lbs. $ CF55 E1015 Frg Legs 191 lbs. weight t 265 lbs. $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid, Rev I Page 2

15 3. FOOTPLATE OPTIONS Ftrest Ftrest Optins 186F229 Aluminum Tubular High Munt Ext Tubes (NA w/ 186DI08 K F274 Aluminum Tubular w/ Snap On Cver $30.00 Tubular ftrest) $ F276 K0040 Angle Adjustable Flip Back $ DI03 K0038 Leg Strap $ F51 186F111 K0040 K0040 Platfrm Ftrest Ultra Lite Platfrm Ftrest NA w/ 14" wide and 2" inset, NA w/ wide w/ 0" inset $ DI04 186DI05 186DI07 186DI02 186DI06 K0038 Extra Leg Strap Gel Hanger Cver Neprene Impact Guards Wear Pads Psitin Plates (NA fr Tubular Ftrest) $35.00 $ $50.00 $50.00 Adaptive Platfrm Spacer Only available with Platfrm Ftrest. NA w/ Ultra Lite Platfrm. 186AD1 186AD2 186AD3 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer 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 NA w/ 8"- 10" fixed height NA 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 JAY J3 Back J3 Back T rder a J3 Back please 186JB01 select Omit Back Uphlstery. See J3 Back Price List Order Frm fr Part #'s. Ultra Lightweight Aluminum Fixed Backrest Select back height. 8", 9", r 10" nly available mit push handles. Military Service Patches 17", 18", r 19" nly available with fld dwn push handles Only available n tensin adjustable uphlstery and Jay 3 Back 186BB21 8" $ BB17 14" $ VU1 US Marines Patch $ BB20 9" $ BB18 15" $ VU2 US Army Patch $ BB13 10" $ BB19 16" $ VU3 US Navy Patch $ BB14 11" $ BB10 17" $ VU4 US Air Frce Patch $ BB15 12" $ BB11 18" $ VU12 Cast Guard Patch $ BB16 13" $ BB12 19" $ VU5 186VU8 Purple Heart Purple Heart with Marines Patch $90.00 $ Twel Bar 186VU9 Purple Heart with Army Patch $ QT01 186QT02 Standard Style - 4" Offset Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with $ VU10 186VU11 186VU13 Purple Heart with Navy Patch Purple Heart with Air Frce Patch Purple Heart with Cast Guard $ $ $ " & 20" wide 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 Center f Gravity Preset 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" Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid, Rev I Page 3

16 See FIGURE CI1 186CI2 186CI4 Camber (NA w/ Mag wheel) 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 3.5" Max Frnt t Rear Seat Hgt. 17", 18" Seat Depth 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 " 5. REAR SEAT HEIGHT SET UP (CONT.) Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Pwer assist nt available n the Q7. Cntact Built 4 Me fr Spinergy clr ptins. 186RW3 186RW8 186RW1 186RW90 186RW91 186RW92 186RW93 186RW94 186RW06 186RW10 186RW16 186RW28 186RW95 186RW96 186RW97 186RW32 186RW98 20" Mag 22" Mag 24" Mag 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 24" Spinergy LX Black Spkes $ $ $80.00 $ $ $ $ $ $ $ $ $ RW99 25" Spinergy LX Black Spkes $ RW40 26" Spinergy LX Black Spkes $ RW50 24" Muntain $ Wheel Ultra Mag Lite Spke Spinergy 186RT28 Tire Lightweight Schwalbe Speed Run Tire Full Ply Tire 20,22,24 20,22,24 High Pressure Clincher 22,24,25,26 22,24,25 22,24,25,26 Handrim Kik Mak Black 24 24,25 24,25 Natural Fit Handrims nly available in 22", 24", & 25" Knbby V-TRAK HR1 Aluminum Andized Pneumatic 20,22,24 20,22,24,26 22,24,26 Plastic Cated NA w/ 25" & 26" 186HR4 Pneumatic w/airless Insert 20,22,24 20,22,24,26 22,24,26 Lite Spke Wheels Schwalbe Marathn Schwalbe Speed Run 24 24,25,26 24,25 22,24,25 24,25 24,25,26 24,25 186HR22 186HR23 Natural Fit - Standard Grip Natural Fit - Super Grip $ $ " = 489 mm 24" = 540 mm 25" = " = HR30 186HR31 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 NA w/ Ultra Lightweight Wheels 186AX1 186AX13 Axle Quick Release Steel Quad Quick Release Steel Only available with Mag Wheels $90.00 Rear Wheel Tire 186RT3 E2218 Full Ply Tire 186RT6 High-Pressure Clincher 186RT22 E2218 Kik Mak Black 186RT27 Knbby V-TRAK by Kenda 186RT12 Muntain Only available in 24" 186RT1 Pneumatic 186RT2 186RT21 E2213 Pneumatic Airless Insert Schwalbe Marathn Plus Evlutin $80.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid, Rev I Page 4

17 5. 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 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 E0971 Wheel Lck Optins D Nt Munt Anti Tips Anti Tips (Pair) Increases verall width f chair. Sme interferance my exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard NA w/ Height Adjustable Arms 186SG29 K0108 Plastic Lw NA w/ Height Adjustable Arms 186SG35 K0108 Side Guards Aluminum NA w/height Adj. Arms, High Push r Pull Wheel Lcks 6. KEY OPTIONS & ACCESSORIES $60.00 $ $ $ Frame Clr 186C118 Bead Blast 186C2 Black 186C10 Black Opal 186C38 Blue Opal 186C36 Candy Blue 186C14 Candy Purple 186C35 Candy Red 186C128 Cpper 186C6 Frest Green 186C127 Fuchsia 186C126 Glw 186C116 Matte Black 186C117 Matte Green 186C4 Midnight Purple 186C5 Pearl Pink 186C103 Rtbeer 186C114 Sparkle Silver 186C113 Titanium Clr Paint 186C11 Txic Green 186C8 Yellw 186C C43 186C42 Custm Frame Clr Desert Camuflage $ Mssy Oak Camuflage $ Stars & Stripes $ SG36 K0108 Aluminum w/ Fender NA w/ Height Adj. $ Arms, High Push r Pull Wheel Lcks 186SG12 K0108 Carbn Fiber NA w/ Height Adj. Arms, $ High Push r Pull Wheel Lcks Andized Clr Package Frks, Backcane Bracket, Rear Axle Clamp. NA w/ Frg Legs- andized parts Side Guard - Clr Optin can be rdered separately Available with Aluminum r Aluminum with Fender. 186EB07 Black 186GE01 Black 186EB08 Blue $ GE02 Matching Frame- Standard Clrs 186EB09 Green $ GE03 Matching Frame- Custm Clr Psitining Belt $ EB10 186EB11 186EB12 Purple Red Ti Grey $ $ $ A117 E0978 Belt 2" Aircraft Buckle w/clamps $ A118 E A141 E0978 Belt 2" Aircraft Buckle Padded w/clamps Belt 1.5" Aut Buckle Universal w/clamps $ C108 Zebra (Chse abve base clr) Std with White unless abve base paint is chsen NA w/ Black Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3, Fax: (800) $ Spke Guards 186A23 K0065 Black Spke Guard 186A302 K0065 Quickie "Q" Clear $ $ Additinal Pack Accessries 186A1 Backpack - Adult $ A2 Backpack - Kids $ A8 Black Seat Puch $ A A83 E2207 Miscellaneus Crutch Hlder Tl Kit $ $45.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid, Rev I Page 5

18 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Cnfirm Via: ZIP: Quickie GT August 2013 EIR3 Ship T: Attentin: Ship T City: ST: Fax Ship T Phne: ( ) Fax: ( ) PO#: Address: Address: ADDITIONAL SHIPPING INFORMATION 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. ZIP: Optin # HCPCS Definitin Price Optin # HCPCS Definitin Price 1. FRAME STYLE & SETUP 145FF1 145FF2 145FF3 145FS34 145FS35 Base Mdel 145WM13 K0005 GT (265 lbs) $2, FA1 145FA8 145FA2 145FS36 Frame Angle (see Figure 1) Frame Inset Per Side (See Figure 2) 0" 1" (NA w/ 12" wide) 2" (NA w/ 12", 13", r 14" wide) Frame Inset Ftrest Width 0 Subtract 0 frm Frame Width 1" Subtract 2" frm Frame Width 2" Subtract 4" frm Frame Width Frame Style (See Figure 3) Classic Frame Perfrmance Frame XTR Suspensin Frame Only available in Perfrmance Frame Set Up $ SK1 Light Shck (up t 180 lbs.) 145SK3 Heavy Shck (up t 265 lbs.) Depth Adjustable Backrest (Optinal) See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. NA n 19" and 20" Seat Depths. 145DP02 145DP03 145DP04 0 Setting Backrest at standard psitin, field adjustable t -1" r -2" -1 Setting Backrest -1" ffset, field adjustable t flush r -2" -2 Setting Backrest -2" ffset, field adjustable t flush r -1" $ $ $ Figure 1 Figure 2 Figure 3 Classic Frame - Traditinal GT seat sling t frnt frame bend angle dimensins. Perfrmance Frame - Seat Sling t frnt frame bend angle is 1.5" shrter than the classic psitin. Frnt f back cane pst t frnt edge f seat sling will remain the same fr bth Classic and Perfrmance. ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 1

19 1. FRAME STYLE & SETUP (CONT) Seat Width See Figure 2. Measure frm utside f seat tube t utside f ppsite seat tube. XTR and J3 Back NA w/ 12" and 13" widths 145S3 12" 145S4 13" 145S5 14" 145S6 15" 145S7 16" 145S8 17" 145S9 18" 145S10 19" 145S11 E " $ Seat Depth See Figure.1 Measures frm frnt f back pst t frnt edge f seat sling. Seat sling will be 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 145SD5 12" 145SD6 13" 145SD7 14" 145SD8 15" 145SD9 16" 145SD10 17" 145SD11 18" 145SD12 19" 145SD13 E " $ FRONT SEAT HEIGHT SET UP Frnt Seat Height See Figures 4 and 5 145SH " 145SH14 16" 145SH21 19" 145SH " 145SH " 145SH16 17" 145SH24 20" 145SH " 145SH " 145SH18 18" 145SH27 21" Frnt t Rear Seat Height Differences D Figure 4 See Figures 5 and 6 145CF27 145CF45 145CF32 Frame Depth Max Seat Sqeeze 12"/13" 2.5" 14"/15" 3.0" 16"/17" 3.5" 18"/19" 4.0" 20" 4.5" Caster Wheels 145CW1 3" Micr 145CW3 4" Lw Prfile Plyurethane 145CW31 4" Micr Lighted $ CW72 4" x 1" Aluminum Plyurethane $ CW44 4" x 1.25" Semi Pneumatic $ CW64 4" x 1.5" Aluminum Sft Rll $ CW5 5" Lw Prfile Plyurethane 145CW51 5" Micr Lighted 145CW6 5" Sft Rll (Grey) NA w/ Frg Legs 145CW65 5"x 1" Aluminum Plyurethane $ CW7 5"x 1.5" Semi Pneumatic 145CW66 5"x 1.5" Aluminum Sft Rll $ CW34 6" Plyurethane 145CW35 6"x 1.5" Semi Pneumatic 145CW68 6"x 1.5" Aluminum Sft Rll $ Caster Frk Shrt Frk Shrt Wide Frk (w/ 1.25" r 1.5" caster) Tall Wide Frk Caster Frk Suspensin 145CF53 E1015 Frg Legs 0 weight t 100 lbs $ CF54 E1015 Frg Legs 101 lbs weight t 190 lbs $ CF55 E1015 Frg Legs 191 lbs weight t 265 lbs $ Figure 5 Frnt Frk STFH Shrt/Single Shrt Wide Tall Wide Frg Legs 3" 16"-20" 16"-20.5" 16.5"-21" 17.5"-21" 4" 16"-20.5" 16.5"-21" 16.5"-21" 17.5"-21" 5" 17",18",19",20",21" 17"-21" 17"-21" 18.5"-21" 6" NA NA 18"-21" 19",20",21" Caster 75 Frame Angle 80 Frame Angle 85 Frame Angle Caster Frk Size Shrt, Shrt W, Tall W 3" Single Sided Frglegs Shrt, Shrt W, Tall W 4" Single Sided 5" 6" 3" 4" 5" 6" 3" 4" 5" 6" Figure 6 Tubular/Flat Flared Platfrm Inset Inset Inset 0" 1" 2" 0" 1" 2" 0" 1" 2" NA NA NA NA NA Frglegs NA 2" Shrt, Shrt W, Tall W NA NA NA Single Sided NA NA NA Frglegs NA NA NA.5" Tall Wide NA NA NA 2" Frglegs NA NA NA NA 1.5" NA.5" Shrt, Shrt W, Tall W NA Single Sided NA Frglegs NA All Frks NA Single Sided NA Frglegs NA NA NA Shrt, Shrt W, Tall W NA NA NA 1" Single Sided NA NA NA 1" Frglegs NA NA NA 2" Wide NA 1" NA NA NA 1" Frglegs NA NA NA NA NA NA 2" All Frks NA Single Sided NA Frglegs NA Shrt, Shrt W, Tall W NA.5" Single Sided NA.5" Frglegs NA NA NA.5" Shrt NA.5" NA NA 2".5" Shrt Wide/Tall Wide NA 1" NA NA 2".5" Single Sided NA 1" NA NA 2".5" Frglegs NA 1.5" NA NA NA 1.5" Tall Wide NA 2" NA NA NA 2" Frglegs NA NA 1.5" NA NA NA NA NA 1.5" = G = N G # = "Sft" G with limited seat angle Min seat angle listed in cell ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 2

20 3. FOOTPLATE OPTIONS Ftrest Adaptive Platfrm Spacer Heel lp r leg strap nt included, See Ftplate Optins Sectin NA with Tubular Ftrest 145F228 Aluminum Tubular 145AD1 Adaptive Platfrm 2" Spacer 145F229 Aluminum Tubular Lng 145AD2 Adaptive Platfrm 4" Spacer 145F230 Aluminum Tubular w/ Flat Cver 145AD3 Adaptive Platfrm 6" Spacer 145F231 Aluminum Tubular Lng w/ Flat Cver nc 145F234 K0040 Aluminum Platfrm (Ang. Adj.) Ftrest Optins 145F235 K0040 Aluminum Platfrm Lng (Ang. Adj.) 145HL5 K0038 Leg Strap $35.00 High Munt Platfrm NA w/ 12", Remvable Snap On Cver 145DI01 145F278 K " W with 1" r 2" Inset r 14" r NA w/ Platfrm Ftrests $ " W with 2" insets. 145DI02 Wear Pads NA w/ Platfrm Ftrests $ A179 K0108 Psitining Plates fr Platfrm Ftrest $ A54 K0038 Extra Leg Strap $ REAR SEAT HEIGHT SET UP Rear Seat Height Rear Wheel Tire 14" & 14.5" nly available with 20" rear wheel. NA with Amputee Axle Plate. See Availability Matrix 13" & 13.5" nly available with 20" r 22" rear wheel. NA with Amputee Axle Plate. 145RT1 145RH11 13" 145RH " 145RT2 145RH13 14" E2213 Pneumatic Pneumatic w/ Airless Insert $ RH " 145RT3 E2218 Full Ply 145RH15 15" 145RT6 145RH " 145RH17 16" 145RT27 145RH " 145RH19 17" 145RT21 145RH " High-Pressure Clincher Knbby V- Trak Schwalbe Marathn Plus Evlutin 145RH20 18" 145RT22 E2218 Kik Mak Black 145RH " 145RT12 145RH21 19" Muntain Tire 145RH37 145RH " 20" Rear Tire & Wheel Matrix Rear Wheel Size Ultra Lightweight Wheels nly available with aluminum anndized handrim Cntact Built 4 Me fr Spinergy clr ptins 145RW3 145RW8 145RW1 145RW90 145RW91 145RW92 145RW93 145RW94 145RW77 145RW78 145RW28 145RW42 20" Mag Wheel 22" Mag Wheel 24" Mag Wheel 20" Lite Spke Wheel 22" Lite Spke Wheel 24" Lite Spke Wheel 25" Lite Spke Wheel 26" Lite Spke Wheel 22" Ultra Lightweight Spke Wheel 24" Ultra Lightweight Spke Wheel 22" Spinergy SPOX Black 24" Spinergy SPOX Black $ $ $80.00 $ $ $ $ RW96 25" Spinergy SPOX Black $ RW44 26" Spinergy SPOX Black $ RW32 22" Spinergy LX Black $ RW88 24" Spinergy LX Black $ RW99 25" Spinergy LX Black $ RW40 26" Spinergy LX Black $ RW50 24" Muntain $ Wheel Ultra Mag Lite Spke Tire Lightweight Spinergy Pneumatic 20,22,24 20,22,24,26 22,24,26 Pneumatic w/ Airless Insert 20,22,24 20,22,24 22,24 Full Ply 20,22,24 20,22,24 High-Pressure Clincher 22,24,25,26 22,24 22,24,25,26 Knbby V Trak by Kenda Schwalbe Marathn 24,25,26 24,25,26 Kik Mak Black 24 24,25 24,25 22" = 489 mm 24" = 540 mm 25" = " = 590 Handrim Aluminum and Plastic are nt available n all wheels in all sizes. Natural Fits are NA w/ 26". Handrim Selectin nt applicable with Xtender Pwer Assist 145HR1 Aluminum Andized 145HR4 Plastic Cated NA w/ 25" & 26" Lite Spke Wheels 145HR22 Natural Fit - Standard Grip $ HR23 Natural Fit - Super Grip $ HR30 Natural Fit LT - Standard Grip $ HR31 Natural Fit LT - Super Grip $ HR24 Spinergy Flex Rim Only available n Spinergy LX wheels 24" & 25" $ HR8 8 Oblique Prjectins NA w/ Kik tires, nly available with Mag r Spke $ HR7 Omit Handrim NA w/ Ultra Lightweight Wheels ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 3

21 4. REAR SEAT HEIGHT SET UP (CONT) Xtender Pwer Assist Rear seat height is 18.5" t 20" & 0 camber, NA w/ Amputee Axle, Padded Swing Arms. Frnt T Rear Seat Height Range 0 t 1" difference, 24" wheels nly. Nt available with XTR r standard rear suspensin. Anti-Tips n charge with Xtender Xtender Pwer Assist 4X Multiplier 145XT2 E0986 $6, NICKEL Rear Suspensin Rating Selectin nt required fr XTR Suspensin 145SV04 145SV05 145SV06 Frm 0 weight t 100 lbs (Yellw) Frm 101 lbs weight t 190 lbs (Red) Frm 191 lbs weight t 265 lbs (Blue) 145XT3 E0986 Xtender Pwer Assist 4X Multiplier LITHIUM $7, Please select ne f the fllwing handrim ptins 145XH3 Plastic Cated 145XH4 Stainless Steel Xtender - Other Optins 145XA1 Spare NiMH Pwer Pack - NICKEL $1, XA7 Spare NiMH Pwer Pack - LITHIUM $1, AX1 145AX13 Axle Quick Release Steel Quad Quick Release Only available with Mag wheels $90.00 Axle Plates Selectin nt required fr XTR Suspensin 145AL40 Standard Shrt (COG 1" t 4.5") Sme limitatins with STFH 145AL43 Standard Lng (COG 1" t 4.5") 145AL37 E0959 Amputee (COG -1" t 2.5") $ AL38 E1015 Suspensin (COG-.5 t +3) NA with XTR Suspensin Frame $ AL39 Xtender (COG 1") Rear Seat t Flr Height Shrt Axle Plate- Wheel Size: (559) Camber 0,3,6 available with std frame. 0,4,8 available with XTR frame 145CI CI CI CI CI5 8 will be factry set at 1.5", Xtender 1" 145CC11 145CC10 145CC12 145CC1 145CC2 145CC3 145CC4 145CC5-1" -.5" 0".5" 1" 1.5" 2" 2.5" 145CC6 3" 145CC7 3.5" 145CC8 4" 145CC9 4.5" Center f Gravity Measure frm frnt f back pst t center f rear axle. XTR Suspensin Frame Figure 7 5. BACKREST Back Type 145BT3 Nn-Flding Backrest 145BT82 Flding Lck Dwn Angle Adj Height Adjustable Backrest 145B110 10" - 14" Back Height 145B127 12" - 16" Back Height 145B111 14" - 18" Back Height 145B137 16" - 20" Back Height Back Uphlstery 145BU1 Standard Uphlstery 145BU8 Adjustable $ BU57 Vented $ BU14 Omit Uphlstery (Use w/ JAY Backs) -$15.00 JAY J3 Back 145JB01 JAY J3 Back See OF Military Service Patches Only available n tensin adjustable uphlstery and Jay 3 Back 145VU1 US Marines Patch $ VU2 US Army Patch $ VU3 US Navy Patch $ VU4 US Air Frce Patch $ VU12 US Cast Guard $ VU5 Purple Heart $ VU8 Purple Heart with Marines Patch $ VU9 Purple Heart with Army Patch $ VU10 Purple Heart with Navy Patch $ VU11 Purple Heart with Air Frce Patch $ VU13 Purple Heart with Cast Guard $ PH6 145PH5 145PH2 Push Handles Integral Push Handles Fld-Dwn Push Handles NA w/ 10-14" Back Height r Standard Uphlstery. Omit Push Handles $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 4

22 5. ARMREST Includes angle adjustable receiver hardware. NA w/ Xtender. Sme limitatins may exist w/ integral push handles, sme RSHs and wheel sizes 145AA18 E0973 Padded Swing-Away - Standard $ AA11 145AA29 Armrest - Padded Swing Away Armrest - Height Adjustable E0973 Single Pst Ht. Adjust. Std (8.5"-13.5") $ E0973 Single Pst Ht. Adjust. Lw (7"-11") $ Armpad - Fr Height Adjustable Suggest using classic mdel fr tray tables 145AM23 145AM21 Desk Length (10") Classic Desk Length (10") Cntur 145AM24 Full Length (14") Classic 145AM22 Full Length (14") Cntur 6. Key Optins & Accessries Nt all wheel lcks available in all seat depths, wheel sizes and COG settings. XTR suspensin nly available w/ high munt push 145WL1 High Munt Push 145WL2 High Munt Pull 145WL27 Erg Scissr 145WL30 Cmpact 145WL10 Omit Wheel Lck 145WL12 D Nt Munt Extensin Handle Only available w/ High Munt Push r Pull Wheel Lcks 145EH7 E0961 Extensin handles (Pair) $60.00 Grade Aid Only available w/ high munt push r pull. NA w/ clincher, ply, Kik, r Schwalbe, r Xtender 145GA1 E0974 Grade Aid $ AT1 145AT3 145SL1 145SL6 145CU1 Wheel Lck Anti Tips E0971 Anti Tips (Pair) $ Omit Rear Anti Tip Seat Sling Standard Seat Sling Omit Seat Sling -$15.00 Cushin K0669 2" Cushin 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 145JC20 Cushin Name r Part # Price List Width: Depth: Side Guards All side guards NA w/ Height Adj. Arms. Sme interferance my exist w/ padded SA arms at lwest settings 145SG33 K0108 Plastic - Standard 145SG29 K0108 Plastic - Lw 145SG12 K0108 Carbn Fiber NA w/ push r pull wheel lcks $ Pack Accessries 145A1 Quickie Backpack Black $ A2 Quickie Kids Backpack Black $ A8 Seat Puch Black $ A500 Gel Cver Hanger/Frame $ A994 Gel Cver Swing Away Arm $ Psitining Belt 145A142 E0978 Belt 1.5" Aut Buckle Universal w/clamps $ A12 E0978 Belt 2" Aircraft Buckle $ A13 E0978 Belt 2" Aircraft Buckle Padded $ A23 145A302 Spke Guards K0065 Quickie Black Spke Guard $ K0065 Quickie Clear Spke Guard $ Miscellaneus 145A32 145IG6 E0950 Wheelchair Tray Neprene Impact Guards $ A51 E2207 Crutch Hlder Only available with Integral r Fld Dwn push handles $ A85 Blt-On Push Handles $ A96 Presta Valve Adapter $ A83 Tl Kit $45.00 ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 5

23 6. Key Optins & Accessries (Cnt) 145C2 145C10 Frame Clr Black Black Opal 145C38 Blue Opal 145C36 Candy Blue 145C14 Candy Purple 145C35 Candy Red 145C128 Cpper 145C6 Frest Green 145C127 Fuchsia 145C126 Glw 145C116 Matte Black 145C117 Matte Green 145C4 Midnight Purple 145C5 Pearl Pink 145C103 Rtbeer 145C114 Sparkle Silver 145C113 Titanium Clr Paint 145C11 Txic Green 145C8 Yellw Andized Clr Package Camber tubes are titanium grey except fr the black ptin. Frg Legs black nly. Black nly w/ amputee, Xtender, suspensin axle plates. 145EB02 Black 145EB06 Blue $ EB05 Green $ EB04 Purple $ EB03 Red $ EB01 Ti Grey $ Custm Frame Clr 145C112 Desert Camuflage $ C43 Mssy Oak Camuflage $ C42 Stars & Stripes $ C108 Zebra (Chse abve base clr) Std with White unless abve base paint is chsen NA w/ Black $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Quickie GT, REV. S Page 6

24 Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: ZIP: Quickie QRi Nvember 2012 Ship T: Attentin: Address: Dealer Phne: ( ) Fax: ( ) Address: Cnfirmatin Ship T City: ST: ZIP: Cnfirm Via: Fax Ship T Phne: ( ) Fax: ( ) Optin # HCPCS Definitin Price Optin # HCPCS Definitin EIR5 1. FRAME STYLE & SETUP PO#: ADDITIONAL SHIPPING INFORMATION 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. Price Base Mdel QRi (265 lbs) 202WM81 K0005 Classic Frame Style $1, E1236 Applies with certain sizes Figure 1 Figure 2 Transit 202TO1 Transit $ Frame Angle (see Figure 1) 202FA FA FA2 85 Frame Inset Per Side (See Figure 2) 202FF1 0" 202FF2 1" (NA w/ 12" wide) Frame Inset Ftrest Width 0 Subtract 0 frm Frame Width 1" Subtract 2" frm Frame Width Seat Width Measure frm utside f seat tube t utside f ppsite seat tube. 202S3 12" 202S4 13" 202S5 14" 202S6 15" 202S7 16" 202S8 17" 202S9 18" 202S10 19" 202S48 E " $ Seat Depth Measures frm frnt f back pst t frnt edge f seat sling. Seat sling will be 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 202SD5 202SD6 202SD7 202SD8 202SD9 202SD10 12" 13" 14" 15" 16" 17" 202SD11 18" 202SD12 19" 202SD13 E " $ ORDER INFORMATION: Custmer Service: Fax: Specificatins are subject t change withut ntice. Cpyright 2012 Sunrise Medical (US) LLC. (11.05) Prject Rme, REV. A Page 1