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1 order surname, first name street ZIP/city country quote phone mobile diagnosis* signature client *Depending on diagnosis, such as in the case of quadriplegia, lateral support may be required, depending on point of paralysis. In these kind of scenarios, restraint system is a pre-requisite. pos. order-no. gross price model myskate v1.1 SLMS ,00 basic model, 250 Watt, Li-Ionen Akku (1,6kg), 36V/154,8Wh, power supply EU 110V-230V, total weight off 8,9 Kg plus adapter, charge level indicator LED/ handling: right, incl. parking rack and increased gradeability colors: while stocks last ordering options self-assembling SLAU ,00 assembling by supplier SLAU ,00 adapter unit frame handle/bracket VARIOLOC v1.1 SLAD ,00 joints for adapter unit SLAD ,00 shipping (per myskate) german parcel SLVA ,00 international SLVA 0005 depending on country handling brake right SLBG ,00 left (standard) SLBG ,00 handling acceleration right (standard) SLBG ,00 left (modification: accelerate by pushing backwards!) SLBG ,00 handling tetra tetra clip amount: SLBG ,00 each tetra brake throttle/turning (only assembling by supplier with customer) SLBG ,00 tetra accerleration throttle (only assembling by supplier with customer) SLBG ,00 page 1 of 5

2 pos. order-no. gross price steering ZoomRise 13 30mm matt black SLLE ,00 Lady Town 10 silver SLLE ,00 Chopper 10 matt black SLLE ,00 not discountable foldable handlebar anodized/flat 0 SLLE ,00 handlebar extension (to reduce distance between user and handlebar), only in combination with SLLE 0004 SLLE ,00 replacement battery (1,6kg) for quick removal SLOP ,00 options not discountable prices exclude VAT cash in advance Rehability Reha-Fachhandel GmbH UST-ID-Nr: DE HRA AG Mannheim carry-on bag, with straps SLOP ,00 set of lights LED SIGMA Speedster/HIRO, StVZO compliant set, incl. USB charger SLOP ,00 set of lights LED INFINI, with USB charger, no StVZO admission SLOP ,00 R+K Klickfix phone bag for smartphones with varioattachment quad-adapter SLOP ,00 bottle hoder ELITE custom race GFK black & Klickfix bottlefix (removeable), holder included SLOP ,00 rear mirror Spin, tiltable SLOP ,00 handlebar indicator LED WingLights Fixed CYCL SLOP ,00 B-Tourist shopping cart, max 30kg SLOP ,00 JCMASTER LED backlight with direction indicator SLOP ,00 Volksbank Weinheim BLZ: KtoNr: IBAN: DE BIC: GENODE61WNM total price Commerzbank AG BLZ: KtoNr: IBAN: DE BIC: DRESDEFF670 page 2 of 5

3 information regarding the wheelchair wheelchair manufacturer: model: year of construction: foldable SLRS 0001 not foldable SLRS 0002 legrest integrated SLBS 0001 removable SLBS 0002 dimensions (in cm) seat width: rear seat height: foot length: seat depth: lower leg length: back shell available: MATRIX JAY TARTA custom made Please be advised that permission to operate myskate (15 km/h) may vary from country to country. In some countries, operation may only be permitted on private property, and not in general traffic. For participation in traffic, Germany requires a TÜV plaque (SLOP 0008 or can be privately obtained at your local TÜV office), as well as an annual insurance (SLOP 0009, alternatively private coverage). Your signature when ordering will confirm awareness of the facts above and approve delivery of a 15 km/h myskate version. I herewith confirm that I am aware of the fact that in Germany myskate (15/h version) can only be operated with corresponding permission* and with insurance plate in public traffic. In case of operating myskate in another country, I consent to informing myself about all provisions and legal requirements in question. * TÜV will only issue permission to operate for a fee once individual examination of wheelchair-myskat&e tandem has been completed. Signature of customer:... Name of customer (in block lettrs):... City, date:... page 3 of 5

4 SLMS 0002 Display SLBG 0005 SLBG 0006 SLLE 0001 SLLE 0002 SLLE 0004 SLLE 0005 SLAS 0001 SLOP 0001 SLOP 0002 SLOP 0003 SLOP 0004 SLOP 0005 SLOP 0006 SLOP 0010 SLOP 0007 SLOP 0014 page 4 of 5

5 ref.-nr. feature description 1 shape and material 1.1 shape one-wheel traction device 1.2 supporting elements Aluminium / steel 1.3 lining/casing plastic shell 1.4 coupling element mounted husk with safety pin 1.5 frame aluminium, anodized 1.6 frame tube aluminium, anodized 1.7 extension tube aluminium, anodized 1.8 handle bar height and angle adjustble 2 dimensions 2.1 total weight with battery or coupling rod starting at 8,9 kg 2.2 dimension main tube tube 30 x 2,5 mm, alu 2.3 dimension extension tube tube 25 x 2,0 mm, alu 2.4 length of extension 130 mm bei shaft length QAS of 230 mm 3 drive 3.1 engine 250W/36V brushless 3.2 reach Depending on driver / weight (approx. 20 km) 3.3 speed Max. < 15 km/h 3.4 power transmission gearless 3.5 slope depending on surface 4 battery and charger 4.1 battery system replaceable bottle-shapped battery 4.2 external dimensions 286 x 100 x 107 mm 4.3 cell chemistry Li-Ion 4.4 capacity/voltage 154,8 Wh/36V 4.5 time to recharge Ca. 2-3 h 4.6 max. recharching cycles > battery weight 1,6 kg 4.8 display Battery display with 4 LED 4.9 charger lightweight design 230V, with power cord 5 controller 5.1 engine controller electronic 36V 500W 5.2 speed control thumb and twist grip 5.3 recuperation no 5.4 main switch/ignition lock on battery & display 6 wheels and brakes 6.1 wheel(s) DWG15 engine with 165 mm diameter 6.2 brakes integrated drum brakes 7 safety 7.1 Front / back lights optional 7.2 tilt provision wheelchair integrated system 7.3 switching signal bicycle bell 8 accessories 8.1 provisions for carry-ons bag 9. permission to operate 9.1 max. permisseable speed 14,8 km/h insurance mandatory 9.3 CE requested 10. warranty 1 Year page 5 of 5