R82 Rabbit Up - E0638 / E0642 USD Retail Price List/ Order Form
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1 R82 Rabbit Up - E0638 / E0642 USD Retail Price List/ Order Form Account #: Purchase Order No.: Date: Contact: Mark For: Bill To: Address: City/State/Zip: Phone: Ship To: Address: City/State/Zip: Phone: US Configuration Effective: Rev 3 Rabbit Footplate/Extra Foot Adj. Knee Support Hip/Side Support Back Support Chest Support Tray Head Support A (Total Height) B (Shoulder Height) C (Chest Height) D (Buttock Height) E (Chest Width) F (Shoulder Width) Age Weight Features, incl. in standard price Stander Frame Centre Bar Brake on Castors Angling Spindle Measurements Mobile Stander Frame Centre Bar Driving Wheels Angling Spindle Closed Pushrim Std. Camber Angle Spoke protectors Central brake Size 1 Size 2 Size 3 Size 4 Measurements as a stander inches inches inches inches Overall width (G) 20¼" 21¾" 23¾" 23¾" Length (H) 27¾" 31¼" 31¼" 36½" Total mass 19.8 lbs lbs lbs lbs. Measurements as a mobile stander w/26" wheels w/32" wheels w/32" wheels w/36" wheels Overall width (G) 25" 26¾" 28¾" 28¼" Length (H) 24½" 29½" 29½" 35½" Total mass lbs lbs lbs lbs. Overall measurements Width, inside (G1) 12¾" 14¾" 16¾" 16¾" Overall height (I) * 26 ¼" 39 ¼" 33 ¾" 46 ¾" 39" 51 ½" 47 ¼" 60 ¼" 26½" - 39¼" 33½" - 46½" 39" - 51½" 47¼" - 60¼" Height from foot plate (I1) * 21 ¾" 29 ¼" 29 ½ " 42 ½" 32 ½" 46 ¾" 37 ¾" 56" 21¾ - 29¼" 29½" - 42½" 32¾" - 46¾" 37¾" - 56" Center bar angle (a1) 0 to +30º 0 to +30º 0 to +30º 0 to +30º Foot plate angle (a2) +15º to -10º +15º to -10º +15º to -10º +15º to -10º Standard Camber 8º 6º 6º 4º Center bar length 19¾" 27½" 31½" 39¼" Max load 88.1 lbs lbs lbs lbs. * Measured in upright position and with the foot plate in the lowest position.
2 Description Size Part No. USD Price HCPCS Stander - with brake on castors Rabbit-up, Stander, Yellow $1,372 E0638 Rabbit-up, Stander, Blue $1,407 E0638 Rabbit-up, Stander, Grey $1,442 E0638 Rabbit-up, Stander, Silver $1,547 E0638 Description Size Part No. USD Price HCPCS Rabbit, 22" Wheels, Yellow $2,632 E0642 Rabbit, 24" Wheels, Yellow $2,632 E0642 Rabbit, 26" Wheels, Yellow $2,632 E0642 Rabbit, 26" Wheels, Blue $2,667 E0642 Rabbit, 29" Wheels, Blue $3,297 E0642 Rabbit, 32" Wheels, Blue $3,297 E0642 Rabbit, 26" Wheels, Grey $2,702 E0642 Rabbit, 29" Wheels, Grey $3,332 E0642 Rabbit, 32" Wheels, Grey $3,332 E0642 Rabbit, 32" Wheels, Silver $3,437 E0642 Rabbit, 36" Wheels, Silver $3,542 E0642 (Includes central brake, spindle, spoke protectors, & standard camber). Non-returnable item 2 of 5
3 Chest Support 11" x 15½" x 7½ $205 Chest Support 11" x 20-27" x 7½ 2, $205 Chest Support 16" x 25-32" x 10½ $225 Height and width adjustable Chest Support (Pony Style) 5½" x 8¾" x 4¾ $295 Chest Support (Pony Style) 5½" x 10¾" x 4¾ 2, $295 Chest Support (Pony Style) 5½" x 12¾" x 4¾ $295 Thicker Pad, Custom Order; Approx. lead time: 6-8 weeks Chest Support (Mustang Style) 15½"-25¼" Small $490 Chest Support (Mustang Style) 26¼"-30¾" Medium $510 Chest Support (Mustang Style) 34¼"-44¾" Large $540 Surrounding Pad Style Extra Pad H:4¾ x W:2¼ One Size $61 For Mustang Style Chest Support Cover for Chest Support Small $115 Cover for Chest Support Medium $140 Cover for Chest Support Large $150 Filler Pad 4¼ Small $82 Adds 1" expansion to chest or hip pads Filler Pad 6¼ Large $82 Adds 2" expansion to chest or hip pads Extension for Center Bar 3" One Size $82 Note: Allows chest support to be mounted in a higher position Tray with Storage Box One Size $395 Height Adjustment of Tray One Size $225 Can only be used with Chest Support Tray, Plastic, Grey One Size $385 Abdominal Support (Ea.) 5" x 7½" One Size $160 Pommel and Sacral Support (Ea.) 5" x 7½" One Size $435 NOTE The following items are required when ordering a Head Support: Connecting System for Head Support Headrest of Choice Turtle Bar System Hip Support w/ Pommel Connecting System for Head Support 1, $258 Connecting System for Head Support 3, $258 Required with Head Support Anatomic Head Support A:5½ x B:5½ x C:9½ Small $255 Head Support Cover (Required) Small N/C Anatomic Head Support A:6 x B:5½ x C:10 Medium $255 Head Support Cover (Required) Medium N/C Anatomic Head Support A:6½ x B:5½ x C:12½ Large $255 Head Support Cover (Required) Large N/C Required: Turtle Bar System Short or Long, Connecting System for Head Support AND Hip Support. 3 of 5
4 Swing-away Mounting Brackets - Height, Depth, Angle and Lateral Adjustable Turtle Bar System A: 5, B: 4-8½ Short $230 Turtle Bar System A: 10, B: 4-8½ Long $230 Required with Anatomic Head Support; , or Other types of headrest available, please see Head Supports Order Form Hip Support w/ Pommel 4¼" x 6" x $505 Hip Support w/ Pommel 4¼" x 8-10½" x 3 2, $505 Hip Support w/ Pommel 6¼ x 10-11½" x $560 Height and Width Adjustable, Required w/ Head Support Hip Support, Front Mount 4¼" x 6" x $235 Hip Support, Front Mount 4¼" x 8-10½" x 3 2, $235 Hip Support, Front Mount 6¼" 10-11½" x $265 Height Adjustable Height and Width Adjustable Hip Support w/rotation 4¼" x 6" x $355 Hip Support w/rotation 4¼" x 8-10½" x 3 2, $355 Hip Support w/rotation 6¼" x 10-11½" x $385 Height Adjustable Height and Width Adjustable Height and Width Adjustable, Custom Order; Approx. lead time: 6-8 weeks. Hip Support, Surrounding $555 Hip Support, Surrounding 2, $555 Hip Support, Surrounding $565 Knee Supports (Pr.) 2½" x 2½" $280 Knee Supports (Pr.) 2¾" x 3¼" 2, $355 Knee Supports (Pr.) 2¾" x 4" $355 Hinged Knee Supports (Pr.) 3" $435 Hinged Knee Supports (Pr.) 3¾" 2, $435 Hinged Knee Supports (Pr.) 4½" $435 Flip-up Footplate 12" x 12" $220 Flip-up Footplate 17" x 14" 2, 3, $220 Required with all Footplate Accessories Formed Footplates (Pr.) 6¾" $165 Formed Footplates (Pr.) 4" x 8½" 1, $165 Formed Footplates (Pr.) 4½" x 9½" $165 Flip-Up Footplate Required; or Foot Straps, Plastic Lock (Pr.) Max: 22", A: 13½-20½ One Size $36 Foot Straps, Velcro (Pr.) One Size $51 Hinged Sandals w/straps (Pr.) 3¾" x 8" $135 Hinged Sandals w/straps (Pr.) 4½" x 9½" 2, $135 Hinged Sandals w/straps (Pr.) 6" x 12" $135 Flip-Up Footplate Required; or Individual Footrest w/hinged Sandals (Pr.) $395 Individual Footrest w/hinged Sandals (Pr.) 2, $395 Heel Stop (Pr.) 1½" x 4" Small $56 Heel Stop (Pr.) 4" x 5¾" Large $56 Flip-Up Footplate Required; or of 5
5 Conversion Kits For stander not prepared for driving wheels order driving wheels and central brake system* Driving wheels, 22" closed pushrim $473 Driving wheels, 24"closed pushrim $473 Driving wheels, 26" closed pushrim 1, 2, $473 Driving wheels, 29" closed pushrim 2, $998 Driving wheels, 32" closed pushrim 2, 3, $998 Driving wheels, 36" closed pushrim $1,103 * with spoke protector Central brake system $263 Central brake system 2, $263 Central brake system $263 *for stander not prepared for driving wheels Camber kit Rabbit Up $35 Camber kit Rabbit Up +3/ $35 Camber kit Rabbit Up +6/ $35 Spare Parts QTY Strap for Hip & Chest Support $61 Strap for Hip & Chest Support 2, $61 Strap for Hip & Chest Support $61. Kit for Center Bar $160 Kit for Center Bar $180 Kit for Center Bar $190 Custom order; Approx. lead time: 6-8 weeks Spare Parts QTY Mounting for Back Support 1, 2, 3, $133 Straps for Knee Supports (Pr.) $56 Straps for Knee Supports (Pr.) 2, $56 Straps for Flip-Up Footplate (Pr.) $87 Straps for Flip-Up Footplate (Pr.) 2, 3, $87 Spoke Protector for wheels w/closed push rim (Ea.) 22" $135 Spoke Protector for wheels w/closed push rim (Ea.) 24" $135 Spoke Protector for wheels w/closed push rim (Ea.) 26" $135 Spoke Protector for wheels w/closed push rim (Ea.) 29" $190 Spoke Protector for wheels w/closed push rim (Ea.) 32" $190 Spoke Protector for wheels w/closed push rim (Ea.) 36" $190 **Open Pushrim available upon request Custom order; Approx. lead time: 6-8 weeks HCPCS codes are provided for your convenience and are NOT to be considered billing or legal advice. Providers are responsible for insuring that all appropriate billing codes are used when submitting claims. Proper use of HCPCS codes does not insure coverage or payment. Contact the appropriate payer for coverage information. For shipping rates, please call E Independence Blvd, Matthews, NC Web: Prices in CAD & is subject to change without notice For Quotes and Orders please send completed Order Form to: us.info@r82.com 5 of 5
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May 2014 Kids FAST Order Form Maximum Weight Capacity 80 lbs. 12"Wx14.5"Dx19.5"H Seating Capacity. Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
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C u s t o m e r a n d O r d e r I n f o r m a t i o n Purchase Order * Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Tag v.070118 Shipping Address * * required F r a
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Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription Form Pencoed LPF1U2KSERIES021213D CF35 5AQ LPF0019X Tel: 01656 776222 Fax: 01656 776220 January 2014 email: ordersuk@invacare.com
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Quantum 1450 Group 3 Single Power Order Form Up To 600lbs Weight Capacity Quantum Rehab A Division of Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA 18643 Phone: (866)800-2002 Fax:
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