IT S NOT IMAGINARY. IT S REALITY. BRINGING YOU LITTLE WAVE.

Size: px
Start display at page:

Download "IT S NOT IMAGINARY. IT S REALITY. BRINGING YOU LITTLE WAVE."

Transcription

1 LITTLE WAVE

2 IT S NOT IMAGINARY. IT S REALITY. BRINGING YOU LITTLE WAVE.

3 IMAGINE... A wheelchair that has the ability to move easily within its environment; where the wheels are in the perfect spot so that young people can use all of their strength and leverage to their advantage. A wheelchair that has the ability to change and grow along with the person who is using it; yet it is extremely light, simple to use and easy to transport. ITTLE AVE FRAME CONSTRUCTION The signature 7000 series 1 3/8 aluminium frame construction of our high performance rigid frame chairs is also used to construct our paediatric chair, Little Wave. This frame construction helps keep the chair as light as possible while also keeping it extremely rigid which makes it so much easier to manoeuvre, to move around and to help your child get the most out of every push.

4 MULTI-ADJUSTABLE FLIP-UP FOOTPLATE We realize that clients are always growing and changing and the options you choose for their chair need to be able to accommodate these changes with ease. This footplate allows for an infinite number of positions over time so it can be repositioned as the rider grows. The 6061 aluminum base with carefully machined edges and textured black powder coat finish will withstand the wear and tear of any army or a 5 year old! This footplate also has a strap that allows the rider to lift up their footplate without bending down. TOWER SYSTEM Lightweight design, easy adjustment and sleek profile. The CG adjustment of the Little Wave tower design is simple and straightforward, making it easier to adjust the CG, promoting growth and the proper placement of the wheel base, ensuring your child can always have the access to the wheels they need. Not to mention the clamp design allows placement of the backrest right where it needs to be because you do not need to worry about interference with hardware in order to achieve the seating position required. GROWING WITH YOU Only on the Little Wave do you have the ability to customize your chair with one of 8 different colour options available, at no charge. Each cable is made with patented Spinergy spoke technology. 30,000 fibre strands inside each cable ensure it will not become loose or stretch over time.

5 DEPTH ADJUSTMENT The depth is predetermined by you on the order form so it will be there when you need it. Up to 3 can be selected and is no extra charge. Allowing easy and accessible growth on-frame is important in allowing the chair to grow with the rider over time, through the years. EASY TO MOVE Ki Mobility proudly offers the ultra-sleek and lightweight X-Core TM mags. These wheels have far greater stiffness and rigidity than conventional mags while keeping the weight to only 1 lb more than spokes. Now available in 20, 22 and 24 5TH WHEEL The Little Wave s optional rotating 5th wheel permits more aggressive positioning of the rear wheels, allowing and promoting midline wheel access. Quickly height adjustable to adapt to varied terrain and easily removable, the 5th wheel revolutionizes paediatric mobility.

6 LITTLE WAVE OPTIONAL EXTRAS FRAME OPTIONS FOOTPLATES XP Frame Rigid Transit Little Wave Tower Taper Tubular Paediatric Flip Under Angle Adjustable Rigid Riser BACKREST OPTIONS FOOTPLATES WHEELS Adjustable Height Back Adjustable Height Rigidizer Bar Stroller Handle Bolt-On Push Handle High Mount Mag Spinergy Spox Spoke BACKREST OPTIONS UPHOLSTERY ARMRESTS TIRES Straight w/ Push Handle Tension Adjustable Back Rigid Standard Back T-Arm High Pressure Marathon Pneumatic Pneumatic with Airless Insert ARMRESTS TIRES HANDRIMS Swing Away Tubular Flip Up Armrests Paediatric T-Arm Angle Adjustable Flip Up Arm Full Poly Low Poly Natural Fit Super Grip Poly-Coated

7 HANDRIMS CASTERS FROGS LEGS Projection Aluminium Anodized Hard Anodized Natural Fit Std Lighted Micro caster Frogs Legs Rigid Slotted Fork Unitine HANDRIMS WHEEL LOCKS ANTI-TIPPERS ACCESSORIES Natural Fit LT Super Grip Natural Fit LT Grade Aids Pull or Push to Lock 5th Wheel Rigid Anti Tips Spoke Guards Velcro Adjustable Calf strap WHEEL LOCKS AXLES & AXLE PLATES CASTERS ACCESSORIES Pull or Push w/ Extensions Short Thro Scissor Locks Quad Quick Release Soft Roll Aluminium Removable Side Guards Micro Grip Impact Guards CASTERS Designed & built by 1 Poly Aluminium Poly Pneumatic Micro Caster

8 DEDICATED SERVICES Leckey are committed to providing prompt and efficient service that fits with your needs. Whatever the situation Leckey s dedicated and experienced staff will be there to help. SUPPLY OF CRITICAL COMPONENTS WITHIN 48 HOURS TRAINING PROVIDED TAILORED TO YOUR SPECIFIC NEEDS Service We will work with your NHS Approved Supplier to supply critical components to you within 48hrs enabling you to keep your stock holding to a minimum. We will provide a 2 year warranty with all mobility seating to include annual servicing. Ordering Orders can be placed via your local Leckey representative or directly with us by ing: WCS.orders@leckey.com For dedicated customer service and technical support contact mobility@leckey.com or phone YEAR WARRANTY PLUS ANNUAL 2SERVICING VALUE Leckey Mobility will provide training tailored to your specific needs and will be available to demonstrate new products as and when required. As a valued partner Leckey Mobility will support you in delivering high service levels to your clients. For service policies on all products outside warranty, please contact Leckey s Customer Service department. James Leckey Design Ltd as manufacturer with sole responsibility declares that all products conform to 93/42/EEC guidelines and EN12182 technical aids for disabled persons general requirements and all parts of ISO-7176 test methods. Order forms and spare parts lists to extend the service life of the product and allow reissue are available on request or online at Because we realise that users rely on our products in daily life we have built an after sales service that can be relied upon to deliver fast and effective support.

9 Leckey 19C Ballinderry Road Lisburn BT28 2SA Northern Ireland United Kingdom T: F: E: W: SPECIFICATIONS Standard Weight: Seat Width: Seat Depth: Front Seat Height: Rear Seat Height: Tubing Size: Weight Capacity: Ansi Resna WC-19 Transit: 16 lbs /8 250 lbs. Yes LS321-01

RESIST CONFORMITY. GO ROGUE.

RESIST CONFORMITY. GO ROGUE. ROGUE RESIST CONFORMITY. GO ROGUE. IT IS IN THE SOUL OF THE ROGUE, THE WAY IT STANDS OUT, ITS DEFIANCE OF CONVENTION, ITS INDEPENDENCE THAT SEPARATES IT FROM ALL OTHERS. ROGUE. AN ULTRA RESPONSIVE RIDE.

More information

NOT JUST A WHEELCHAIR. A MEMBER OF THE TEAM.

NOT JUST A WHEELCHAIR. A MEMBER OF THE TEAM. LITTLE WAVE NOT JUST A WHEELCHAIR. A MEMBER OF THE TEAM. EVOLVING AND GROWING WITH YOUR CHILD Seat height, width, depth, CG, caster wing position, seat upholstery, seat pans the most built in adjustment

More information

UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY.

UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY. CATALYST UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY. INNOVATIVE AND PATENTED FRAME DESIGN Catalyst frames are constructed from 7000 series aluminum. A stronger

More information

YOU RE YOUNG. YOU RE ACTIVE. YOU RE YOU. GROWTH WITH AN EDGE. ROGUE XP.

YOU RE YOUNG. YOU RE ACTIVE. YOU RE YOU. GROWTH WITH AN EDGE. ROGUE XP. ROGUE XP YOU RE YOUNG. YOU RE ACTIVE. YOU RE YOU. GROWTH WITH AN EDGE. ROGUE XP. FOCUS ON PUSHING YOUR LIMITS. NOT YOUR CHAIR. Rogue XP is the ultimate performance chair; encouraging you to embrace your

More information

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

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

More information

Frame. Backrest. Seat Depth. Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time free growth kit. 165 lb weight capacity.

Frame. Backrest. Seat Depth. Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time free growth kit. 165 lb weight capacity. Canada Patent Pending AADL #W157 Effective 10/01/2017 Company: Ship To: Account Number: Date: Quote PO Number: RTS: Marked For: Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time

More information

MEDmobility Calgary Trail NW Edmonton AB T6H 2K1 P: F:

MEDmobility Calgary Trail NW Edmonton AB T6H 2K1 P: F: Canada MEDmobility 5711- Calgary Trail NW Edmonton AB T6H 2K1 P: 780-437-3300 F: 780-430-9381 www.medmobility.ca Company: Account Number: Date: Quote PO Number: RTS: AADL #W154 Effective 10/01/2017 Ship

More information

MASS Script Form. Frame. Backrest. Seat Depth. Tsunami ALX K0005 Charge. Sling Position. Seat Width / Seat Depth. Seat Width.

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

More information

MASS Script Form. Frame. Backrest. Seat Depth

MASS Script Form. Frame. Backrest. Seat Depth MASS Script Form Company: Account Number: Date: Quote PO Number: RTS: Marked For: Australian Order Order Effective 01/10/2014 Ship To: Address: City: State: Zip: Phone: Email/Fax: Rogue XP K0005, E1235

More information

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.

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

More information

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151.

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151. This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada AADL CAT # 151 Effective 10/01/2018 Company: Account Number: Date: q Quote q PO Number:

More information

4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity)

4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity) 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 : PO : Vendor : CUSTOM TECHNOLOGIES LIMITED Date

More information

q Little Wave Flip XP-Rigid Base E1233, E1161 $

q Little Wave Flip XP-Rigid Base E1233, E1161 $ Funder: Therapist: Date: q MOH q ACC Marked For: Details: Ship To: Address: City: Postcode: Phone: Email: Notes: q Little Wave Flip XP-Rigid Base E1233, E1161 $ 74 kg weight capacity. Price includes one

More information

4.6. Clinician/ATP/RTS: City: State: C2MA029 * Required

4.6. Clinician/ATP/RTS: City: State: C2MA029 * Required 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.6 P.O. number:* Date: Ship to:* Helio C2 ORDER FORM - USA Company Name:*

More information

4.6. Clinician/ATP/RTS: City: State: VEMA039 * Required. Veloce - FRONT Seat-to-floor height. 16 to 19 Specify desired height: 80.

4.6. Clinician/ATP/RTS: City: State: VEMA039 * Required. Veloce - FRONT Seat-to-floor height. 16 to 19 Specify desired height: 80. 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.6 VELOCE ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*

More information

q Little Wave Flip XP - Rigid Base KF-XPRIGID $

q Little Wave Flip XP - Rigid Base KF-XPRIGID $ Phone 0800 5 222 Fax 0800 275 65 Effective /06/207 Funder: Account Number: Date: Quote PO Number: Therapist: Marked For: Little Wave Flip XP - Rigid Base KF-XPRIGID $ 9.8kg weight capacity. One time free

More information

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan.

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan. MASS Script Form Australian Order Form Effective 05/07/2014 Company: Account Number: Date: Quote PO Number: RTS: Marked For: Ship To: Address: City: State: Zip: Phone: Email/Fax: Catalyst 5Vx K0005 Charge

More information

Little Wave Flip Accessory Flip Chart

Little Wave Flip Accessory Flip Chart Little Wave Flip Accessory Flip Chart Ki Mobility Products Proudly brought to NZ by Permobil New Zealand Limited PH 0800 115 222 FAX 0800 275 365 WWW.PERMOBIL.CO.NZ Flip the script on ordinary Put a flip

More information

Spark Accessory Flip Chart

Spark Accessory Flip Chart Spark Accessory Flip Chart Ki Mobility Products Proudly brought to NZ by Permobil New Zealand Limited PH 0800 115 222 FAX 0800 275 365 WWW.PERMOBIL.CO.NZ 2017/10 Easy to grow The growth capability is built

More information

4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by: Marked for: User manual: PO: Postal Code: Phone:

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

More information

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: City: Province:

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

More information

Account Number: Provider Name: Contact:

Account Number: Provider Name: Contact: Quantum Rehab Discount: Terms: Freight: Taken By: DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered

More information

APEX 4.6. FRONT Seat-to-floor height Caster sizes Height available +- 1/4" ORDER FORM - International. 3" Caster. Specify desired height:

APEX 4.6. FRONT Seat-to-floor height Caster sizes Height available +- 1/4 ORDER FORM - International. 3 Caster. Specify desired height: 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 4.6 APEX ORDER FORM - International P.O. number:*

More information

Custom Manual Options & ACCESSORIES AUSTRALIA 2013

Custom Manual Options & ACCESSORIES AUSTRALIA 2013 Custom Manual Options & ACCESSORIES AUSTRALIA 2013 Casters and Forks CASTERS FORKS Aluminium Soft Roll 4 X 1.5 113395 5 X 1.5 113396 6 X 1.5 113397 Aluminium Polyurethane / Soft Roll Multi Position Fork

More information

Account Number: Provider Name: Contact:

Account Number: Provider Name: Contact: Discount: Terms: Freight: Taken By: Quantum Rehab A Division of Pride Mobility Products Corporation 82 Susquehanna Ave., Exeter, PA 8643 Phone: (866)800-2002 Fax: (866) 707-3422 DME providers are responsible

More information

Height adjustable footplates, equipped with nylon heel loops. Standard with maintenance free PU front (7 ) and rear wheels (24 ).

Height adjustable footplates, equipped with nylon heel loops. Standard with maintenance free PU front (7 ) and rear wheels (24 ). Excel G-lite + Compact foldable aluminium wheelchair Perfect for taking with you wherever you go due to its light transport weight and compact size. Comfortable back upholstery. Height adjustable comfortable

More information

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: C O L O U R S C H U M P - G ORDER FORM Ver.9.0 Rev-072513 DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: Address: Email: City: State:

More information

Please make your selection with a cross in the box Standard feature Free of Charge

Please make your selection with a cross in the box Standard feature Free of Charge Manual Wheelchair Retail Prescription Form Champion161116 Tel: 01656776222 Fax: 01656776220 Email: ordersuk@invacare.com Online spares available at: www.invacare.co.uk JANUARY 2017 Account No : Built in

More information

SEATING CHOICE TITANIUM FRONT FRAME

SEATING CHOICE TITANIUM FRONT FRAME Manual Wheelchair Retail Prescription Form Champion140618 Tel: 01656 776222 Fax: 01656 776220 Email: ordersuk@invacare.com Online spares available at: www.invacare.co.uk July 2018 Account No : Contact

More information

Frame Width. Seating Setup. q 16 q 15 q 14 q 17 q 16 q 15 q 14 Short q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14

Frame Width. Seating Setup. q 16 q 15 q 14 q 17 q 16 q 15 q 14 Short q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14 Phone 0800 5 Fax 0800 5 365 Funder: Account Number: Date: Quote PO Number: Therapist: Marked For: Focus CR $ 36kg weight capacity. Tilt range: -5º anterior to 50º posterior. Effective /0/0 Ship To: Address:

More information

APEX 4.7. FRONT Seat-to-floor height ORDER FORM - USA. Height available +- 1/4" Caster sizes. 3" Caster 14" to 21" Specify desired height:

APEX 4.7. FRONT Seat-to-floor height ORDER FORM - USA. Height available +- 1/4 Caster sizes. 3 Caster 14 to 21 Specify desired height: 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 APEX ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*

More information

STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD

STD +1 +2 STD +1 +2 STD +1 +2 STD +1 +2 STD +1 +2 STD 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:*

More information

Manual Wheelchair Pencoed Technology Park. DEALER Prescription form Pencoed. CF35 5AQ. LPF1U2ULTRALIGHT211113D Tel: Fax:

Manual Wheelchair Pencoed Technology Park. DEALER Prescription form Pencoed. CF35 5AQ. LPF1U2ULTRALIGHT211113D Tel: Fax: Invacare Ltd Manual Wheelchair Pencoed Technology Park DEALER Prescription form Pencoed. CF35 5AQ LPF1U2ULTRALIGHT211113D Tel: 01656 776222 Fax: 01656 776220 LPF0020X email: ordersuk@invacare.com January

More information

Serial Number: Manufacturing Date: /20

Serial Number: Manufacturing Date: /20 Sunrise Medical Head Office: 237 Romina Drive, Unit 3 Concord, ON L4K 4V3, Canada Telephone: +1.800.263.3390 Fax:+1.800.561.5834 csrcanada@sunmed.com www.sunrise.ca Distributor Name: Dealers Name: Contact

More information

Quickie GTX Fixed Frame EIF3, Effective July 2009

Quickie GTX Fixed Frame EIF3, Effective July 2009 Quickie GTX Fixed Frame EIF3, Effective July 2009 Account No: Date: P.O. #: Buyer: Marked For: Drop Ship/Ship To: Name: Address: City: State: Zip Code: Phone Number: The HCPCS codes provided are based

More information

October 2018 EIQ2X. Mark For: Submitting for: Quote Order. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Price. Option # 1. FRAME 002RS1 002RS2

October 2018 EIQ2X. Mark For: Submitting for: Quote Order. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Price. Option # 1. FRAME 002RS1 002RS2 Quickie 2 October 2018 EIQ2X Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV:

More information

Zippie Family. Album

Zippie Family. Album Zippie Family Album Why Zippie? Bright, busy kids are exciting. Everything they do revolves around their independence and their ability to fit in and be part of the gang. When you think of Zippie think

More information

Zippie GS. Growth System

Zippie GS. Growth System Zippie GS Growth System Folds compactly for easy transport Growth system adjusts in width and depth to last kids a long, long time. Versatile design meets most functional needs. Crash Tested for safe bus

More information

TiLite. Please Fax to the TiLite Customer Service Team at or

TiLite. Please Fax to the TiLite Customer Service Team at or - Print as guide for ordering DEALER INFORMATION ler: Adaptive Specialties RTS INFORMATION RTS: Email: SHIP TO INFORMATION Phone: Page 1 of 9 Email: TiLite Information Name: Ship Via: : Please Fax to the

More information

Additional Front Wheel Options Not Shown FW1 3 x.75 Micro-Caster FW14 4 x.75 Plastic Wheel w/poly Tire FW3 4 x.75 Light-Up Micro-Caster

Additional Front Wheel Options Not Shown FW1 3 x.75 Micro-Caster FW14 4 x.75 Plastic Wheel w/poly Tire FW3 4 x.75 Light-Up Micro-Caster front wheels FW2 3 x.75 Light-Up Micro-Caster FW23 3 x1.5 Billet Aluminum Micro Caster w/soft Roll Tire FW19 4 x.75 Performance 5 Spoke Billet Aluminum Wheel w/poly Tire - Silver Hub OR Black Hub FW20

More information

3 A7WC10 E-Motion adaptor Kit (2 adaptors)

3 A7WC10 E-Motion adaptor Kit (2 adaptors) 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 4.7 Helio A7 ORDER FORM - INTERNATIONAL P.O.

More information

Condor Script Form Folding Frame Day Wheelchair 90050

Condor Script Form Folding Frame Day Wheelchair 90050 90050 To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the

More information

Zippie Zone July 2018 EIRZ1

Zippie Zone July 2018 EIRZ1 Zippie Zone July 2018 EIRZ1 Date: SUBMITTING F: Quote Order Dealer Acct #: Dealer: PO#: Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV: PC: Address: Dealer Phone: ( ) Fax: ( ) Address:

More information

Zippie Family. Album

Zippie Family. Album Zippie Family Album Why Zippie? Bright, busy kids are exciting. Everything they do revolves around their independence and their ability to fit in and be part of the gang. When you think of Zippie think

More information

VELOCE 4.7. FRONT Seat-to-floor height ORDER FORM - USA. Caster sizes Height available +- 1/4" 3" Caster 14" to 21" Specify desired height:

VELOCE 4.7. FRONT Seat-to-floor height ORDER FORM - USA. Caster sizes Height available +- 1/4 3 Caster 14 to 21 Specify desired height: 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 VELOCE ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*

More information

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: Phone:

4.2. Ship to: Vendor: Name: Date: Address: Ordered by:   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 orders@motioncomposites.com www.motioncomposites.com 4.2 MOVE ORDER FORM - CANADA

More information

Quickie Q7 Adjustable March 2014

Quickie Q7 Adjustable March 2014 Quickie Q7 Adjustable March 2014 EIR4 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer

More information

Order Form. English Company stamp. Version mudguard (AVAILABLE ONLY WITH REAR WHEELS 24'') Version straight sideguard

Order Form. English Company stamp. Version mudguard (AVAILABLE ONLY WITH REAR WHEELS 24'') Version straight sideguard NONO Date User name Company stamp Rigid frame wheelchair Responsible Wheelchair measures Seat width (LS) 33 36 39 42 45 48 The seat width is measured from the outer sides of the frame, while the distance

More information

noir 2.0 Order Form NONO Carbon fibre frame made-to-measure. English Company stamp Date User name Responsible Seat depth (PS)

noir 2.0 Order Form NONO Carbon fibre frame made-to-measure. English Company stamp Date User name Responsible Seat depth (PS) NONO Date User name Order Form Company stamp Rigid frame wheelchair Responsible Carbon fibre frame made-to-measure. Front height 35 37,5 Frame Angle 40 42,5 Backrest rake adjustable from -4 to +16 85 90

More information

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2,

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2, Quickie QXi AADL EIF6, October 2018 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City:

More information

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: C O L O U R S S PA Z Z - G ORDER FORM Ver.9.0 Rev-072513 DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: Address: Email: City: State:

More information

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: C O L O U R S RAZOR BLADE ORDER FORM Ver.9.0 Rev-072513 DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: Address: Email: City: State:

More information

Condor Script Form Folding Frame Day Wheelchair 90050

Condor Script Form Folding Frame Day Wheelchair 90050 90050 To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the

More information

Quickie QX December 2018

Quickie QX December 2018 Quickie QX December 2018 EIF6 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV:

More information

Quickie QX July 2017

Quickie QX July 2017 Quickie QX July 2017 EIF6 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: Dealer

More information

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018 TRACER EX2 FOLDING WHEELCHAIRS Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018 PROVIDER NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS Invacare Canada

More information

Serial Number: Manufacturing Date: /20

Serial Number: Manufacturing Date: /20 Sunrise Medical Head Office: 237 Romina Drive, Unit 3 Concord, ON L4K 4V3, Canada Telephone: +1.800.263.3390 Fax:+1.800.561.5834 csrcanada@sunmed.com www.sunrise.ca Distributor Name: Dealers Name: Contact

More information

Küschall Ultra Light RETAIL Maximum user weight 130kg (20.5 Stone)

Küschall Ultra Light RETAIL Maximum user weight 130kg (20.5 Stone) Manual Wheelchair Retail Prescription Form UltraLight061216 Tel: 01656776222 Fax: 01656776220 Email: ordersuk@invacare.com JANUARY 2017 Online spares available at: www.invacare.co.uk Account No : Built

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) Freedom 2 Kids

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) Freedom 2 Kids Freedom 2Kids Manual Wheelchair Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Frame Options FD2K Folding Transport Optional (E1236) or (K0005) FD2K-30270 $2085 Note: Transportation

More information

Quickie GTX Swing-Away FSS NET ORDER FORM/PRICE LIST (SIN F-1)

Quickie GTX Swing-Away FSS NET ORDER FORM/PRICE LIST (SIN F-1) 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

More information

C2 FRONT Seat-to-floor Height - Please select your choice. Custom Technologies Limited. 40 Raywood Crescent TAUPO. New Zealand

C2 FRONT Seat-to-floor Height - Please select your choice. Custom Technologies Limited. 40 Raywood Crescent TAUPO. New Zealand 4.7 160 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 Helio C2 ORDER FORM - INTERNATIONAL P.O.

More information

Stallion Script Form Fixed Frame Adjustable Wheelchair 90100

Stallion Script Form Fixed Frame Adjustable Wheelchair 90100 90100 To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the

More information

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"

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.

More information

Quickie 2 January 2014

Quickie 2 January 2014 Mark For: Submitting for: Quote Order Date: Dealer Acct #: Dealer: Dealer Contact: Dealer Address: Dealer City: ST: ZIP: Dealer Phone: ( ) Fax: ( ) Address: Confirmation Email: Ship To City: ST: ZIP: Confirm

More information

4.6. A7 FRONT Seat-to-floor Height - Please select your choice. Stem bolt Length /2 15 1/2 16 1/2

4.6. A7 FRONT Seat-to-floor Height - Please select your choice. Stem bolt Length /2 15 1/2 16 1/2 160 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 4.6 P.O. number:* Date: Ship to:* Company Name:*

More information

Order Form. English Company stamp

Order Form. English Company stamp NONO Date User name Company stamp Rigid frame wheelchair Responsible Wheelchair measures Seat width (LS) 24 27 30 33 36 Seat depth (PS) 27,5 30 32,5 35 37,5 40 Seat depth can be increased by 2,5 or 5 cm.

More information

Invacare Action 3 Junior Large Retail Max User Weight 80Kg (12.5 stone) Standard Base Price: 539 * Configurations may vary to the image shown

Invacare Action 3 Junior Large Retail Max User Weight 80Kg (12.5 stone) Standard Base Price: 539 * Configurations may vary to the image shown Manual Wheelchair Retail Prescription Form ACTION3JUNIORLARGE15112017 Tel: 01656 776222 Fax: 01656 776220 JAN 2018 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer Ref:

More information

RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"

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

More information

Helio A6 ORDER FORM - CANADA

Helio A6 ORDER FORM - CANADA 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 4.7 Helio A6 ORDER FORM - CANADA P.O. number:*

More information

champion carbon Customer weight = Kg Code X Description Dealer SEATING CHOICE DDF0204 küschall Champion Carbon 85 Frame Angle

champion carbon Customer weight = Kg Code X Description Dealer SEATING CHOICE DDF0204 küschall Champion Carbon 85 Frame Angle Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription Form Pencoed. CF35 5AQ LPF1U2CHAMPION211114D Tel: 01656 776222 Fax: 01656 776220 LPF0015Z email: ordersuk@invacare.com January

More information

Order Date: SHIP TO Name: Address: : City: Phone: PRICEE

Order Date:   SHIP TO Name: Address: : City: Phone: PRICEE DEALER Dealer: C O L O U R ECL IPS E Account: P.O.#: Ordered By: Address: City: Phone: Email: Customer Name: Customer Weight: CHAIR INFORMATION ECLIPSE K0005 Adjustable FSH-RSH Capacity 250Lbs NOTE Max.

More information

This wheelchair has a weight limit of 80kg

This wheelchair has a weight limit of 80kg 90355 ATTENTION This wheelchair has a weight limit of 80kg If you require a suspension wheelchair and you currently weigh over 80kgs, please consider the Melrose Shockwave. If you need a wheelchair without

More information

4.8. Name: K0005. Stem bolt Length /2 15 1/2 16 1/ /2 15 1/2 16 1/ /2 16 1/2 17 1/2

4.8. Name: K0005. Stem bolt Length /2 15 1/2 16 1/ /2 15 1/2 16 1/ /2 16 1/2 17 1/2 2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*

More information

TABLE OF CONTENTS VELOCE

TABLE OF CONTENTS VELOCE PARTS MANUAL TABLE OF CONTENTS FRAME CROSSBRACE ASSEMBLY CROSSBRACE KIT CENTRAL SHAFT KIT 6 BASE SHAFT KIT 7 LINK KITS 8 LINK DIMENSION TABLE 9 MOUNTING PLATE 0 BACK WHEELS HANDRIMS SPOKES GUARD FRONT

More information

Order Date : carbon. Tension adjustable seat, option DDA0611 is not possible with seat width 320mm

Order Date : carbon. Tension adjustable seat, option DDA0611 is not possible with seat width 320mm Manual Wheelchair Retail Prescription Form KSeriesCarbon061218 Tel: 01656 776222 Fax: 01656 776220 Email: ordersuk@invacare.com Online spares available at: www.invacare.co.uk January 2019 Customer Ref:

More information

LIVE OUT LIMITS WITH ULTRA LIGHTWEIGHT. researched, tested and delivered. performance, and a customized build,

LIVE OUT LIMITS WITH ULTRA LIGHTWEIGHT. researched, tested and delivered. performance, and a customized build, ULTRA LIGHTWEIGHT You want cutting-edge wheelchair technology to keep pace with the demands of your active life. For over 30 years, QUICKIE has listened, researched, tested and delivered. Through state-of-the-art

More information

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required KDMA063 English Manual (STD) Manuel Français

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:*

More information

Küschall Champion DEALER Maximum user weight 120kg (19 Stone)

Küschall Champion DEALER Maximum user weight 120kg (19 Stone) Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription form Pencoed. CF35 5AQ LPF1U2CHAMPION011113D Tel: 01656 776222 Fax: 01656 776220 LPF0015X email: ordersuk@invacare.com January

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair PRO-CG Adult Manual Wheelchair email: customerservice@freedomdesigns.com TM SE Clear Form Email Form to Customer Service Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Notice: A seating

More information

Quickie 2 EIQ2N Effective April 2011

Quickie 2 EIQ2N Effective April 2011 Quickie 2 EIQ2N Effective April 2011 ACCOUNT #: SHIP TO: DATE: NAME: P.O. #: ADDRESS: BUYER: CITY/ STATE: MARKED FOR: ZIP CODE: PHONE NUMBER: The HCPCS codes provided are based on code verification by

More information

Helio A6 ORDER FORM - CANADA

Helio A6 ORDER FORM - CANADA 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 - CANADA P.O. number:*

More information

ORDER FORM Ver.6 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

ORDER FORM Ver.6 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: C O L O U R S ZEPHYR EVERY DAY ORDER FORM Ver.6 Rev-091211 DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone: Address: Email: City: State:

More information

Kidwalk Seating System User Instructions

Kidwalk Seating System User Instructions Kidwalk Seating System User Instructions The Kidwalk has been designed as a posturally supportive mobility system that moves with the child giving them the freedom to move and walk while keeping their

More information

NXT Pediatric. Manual Wheelchair. Transport Optional Base

NXT Pediatric. Manual Wheelchair. Transport Optional Base Pediatric Manual Wheelchair Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Transport Optional Base Folding (E1234) NXT-30300 $2800 Transport Optional Note: Transportation Option selected

More information

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required MVMA053 MVMA056. MVMA058 English Manual (STD) Dutch Manual

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.

More information

Transformer. Rev C. Aug 15, 2010 Page 1 of 8

Transformer. Rev C. Aug 15, 2010 Page 1 of 8 Transformer Rev C. Aug 15, 010 Page 1 of 8 www.topendwheelchair.com Rev C. Aug 15, 010 Page of 8 www.topendwheelchair.com ITEM PART NUMBER PER CHAIR DESCRIPTION 1 1116570 1 Upper Seat Frame, specs required

More information

champion Standard Base Price 1,875 Standard Features

champion Standard Base Price 1,875 Standard Features Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription Form Pencoed. CF35 5AQ LPF1U2CHAMPION290514D Tel: 01656 776222 Fax: 01656 776220 LPF0015Z email: ordersuk@invacare.com January

More information

BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

BENTLEY. 15 Seat Width 18 Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply. 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.072318 Shipping Address * * required F r a

More information

P R O D U C T C ATA LO G U E

P R O D U C T C ATA LO G U E PRODUCT CATALOGUE Hi, 36 years ago, I was injured in a racing accident. I realised quite quickly that if I wanted a good wheelchair I was going to have to build it myself. What was I looking for? Well,

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair P.R.O. CG Adult Manual Wheelchair TM SE 2241 N Madera Rd Simi Valley, CA 93065 Phone: (800) 331-8551 Fax: (888) 582-1509 www.freedomdesigns.com email: customerservice@freedomdesigns.com Date: Buyer: Company:

More information

MOVE ORDER FORM - CANADA

MOVE ORDER FORM - CANADA 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 MOVE ORDER FORM - CANADA P.O. number:* Date:

More information

STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

STELLAR. 15 Seat Width 18 Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply. 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.072318 Shipping Address * * required F r a

More information

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 1, 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.

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 1, 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. 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

More information

Standard Base Price: 539

Standard Base Price: 539 Manual Wheelchair Retail Prescription Form ACTION3JUNIORSMALL19102018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer

More information

Küschall K Series DEALER Maximum user weight 120kg ( 19 Stone )

Küschall K Series DEALER Maximum user weight 120kg ( 19 Stone ) 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

More information

Quickie 2 AADL - W137

Quickie 2 AADL - W137 Quickie 2 AADL - W137 EIQ2X, October 2018 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer

More information

Adult Manual Wheelchairs. Etac Cross 5 Active. Creating stability for activity

Adult Manual Wheelchairs. Etac Cross 5 Active. Creating stability for activity Adult Manual Wheelchairs Etac Cross 5 Active Creating stability for activity Etac Cross 5 Active - Creating stability for activity Etac Cross 5 Active is the perfect choice for the active wheelchair user

More information

BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e

BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e 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 * Tag Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Shipping Address * * required F r a m e T y

More information

Küschall Champion DEALER Maximum user weight 120kg (19 Stone)

Küschall Champion DEALER Maximum user weight 120kg (19 Stone) Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription form Pencoed. CF35 5AQ LPF1U2CHAMPION240513D Tel: 01656 776222 Fax: 01656 776220 LPF0015W email: ordersuk@invacare.com July 2013

More information

Complement your Zippie with the JAY Zip Cushion and Back designed just for kids! Pediatric Wheelchair Portfolio

Complement your Zippie with the JAY Zip Cushion and Back designed just for kids! Pediatric Wheelchair Portfolio 4 Complement your Zippie with the JAY Zip Cushion and Back designed just for kids! Pediatric Wheelchair Portfolio JAY Zip Back Versatile One Step Release Hardware Easy one step release Fits on wide range

More information