Zippie Zone January 2019 EIRZ1
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- Ann Robbins
- 5 years ago
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1 Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirm Via: Mark Fr: ZIP: Zippie Zne January 2019 EIRZ1 SUBMITTING F: Qute Order Fax Ship T Phne: ( ) Fax: ( ) PO#: Ship T: Attentin: Address: Address: Ship T City: 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. ST: ZIP: a Optin # HCPCS Definitin Price a 1. FRAME STYLE Optin # HCPCS Definitin Price 190FS39 E1235 Frame w/ seating 190FS38 E1235 Zippie Zne w/ seating $2,575 Zippie Zne, Flared w/ seating (Increase f ttal frame length appx. 2" - 1" per side flare.) $2, FS40 190FS41 E1237 E1237 Frame w/ seating Zippie Zne w/ seating Zippie Zne, Flared w/ seating (Increase f ttal frame length appx. 2" - 1" per side flare.) $2,400 $2,425 Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 15"-16" widths = K0005 Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 15"-16" widths = K TRANSIT 190TO41 K0108 Transit Optin (Rear frame extends 1" t accm. transit & nt lse depth adj. range; w/ 18" depth; w/ seat ht. belw 15" w/ inset frame) $ FA8 3. FRAME SETUP/ ANGLE 80º Frame Angle 190QE01 4. ZIPPIE PACKAGE Z Perfrmance Package Single Sided Frk $ FF1 190FF2 Frame Inset Per Side (Ftrest) 0" 1" ( 8"-9" frame width r with flared frame) Ultra Lightweight Wheel Spke Guards Clear Zippie Cmpact Wheel Lck Retail Value Package Price $250 $115 $125 $615 $ FRAME COL Standard Clrs Standard Matte Clrs 190C140 Aztec Gld 190C116 Matte Black 190C118 Bead Blast 190C151 Matte Black Cherry 190C2 Black ( as base w/ Zebra) 190C152 Matte Purple 190C141 Black Cherry 190C150 Matte Electric Blue 190C10 Black Opal 190C149 Matte Evergreen 190C38 Blue Opal 190C36 Candy Blue Custm Clrs 190C14 Candy Purple 190C43 Mssy Oak Camuflage $ C35 Candy Red 190C42 Stars and Stripes $ C142 Electric Blue Zebra (Chse base clr abve: White Std. 190C C143 Evergreen black) $ C126 Glw 190C144 Green Apple Andized Clr Package 190C147 Ht Sparkle Pink Frks, Backrest Bracket, Rear Axle Sleeve; If Frg Legs are chsen, frks will be black 190C148 Mauve Pink 190EB07 Black 190C103 Rtbeer 190EB08 Blue 190C114 Sparkle Silver 190EB13 Gld 190C145 Sunrise Orange 190EB09 Green 190C113 Titanium Clr Paint 190EB11 Red 190C8 Yellw 190EB12 Ti Grey Custmer Service: Fax: rders@sunmed.cm Web: Page 1
2 4. FRAME WIDTH 190W35 8" ( w/ 17"-18" depth) 190W4 13" 190W36 9" ( w/ 17"-18" depth) 190W5 14" 190W1 10" ( w/ 17"-18" depth) 190W6 15" 190W2 11" ( w/ 17"-18" depth) 190W7 16" 190W3 12" 5. SEAT DEPTH (FRAME DEPTH) Fr additinal caster/wheel clearance yu can chse a different frame length and sling depth (i.e. shrter sling vs lnger frame t allw mre wheel/caster cmbs.) 190SD1 8" (Frame grws 9" -11") (Only avail. With 18" rear wheels and 3" casters) 190SD7 190SD8 190SD9 14" (Frame grws 15" - 17") 15" (Frame grws 16" - 18") 16" (Frame grws 17" - 18") 190SD2 9" (Frame grws 10" - 12") 190SD10 17" (Frame grws 18") 190SD3 10" (Frame grws 11" - 13") 18" (N Depth Grwth) 190SD11 190SD4 11" (Frame grws 12" - 14") ( with Transit) 190SD5 12" (Frame grws 13" - 15") 190SD6 13" (Frame grws 14" - 16") 190GJ1 190GJ2 190GJ3 190GJ4 190GJ5 6. SLING DEPTH Fr additinal caster/wheel clearance yu can chse a different frame length and sling depth (i.e. shrter sling vs lnger frame t allw mre wheel/caster cmbs.) 8" (Sling Grws 9"-10") 190GJ6 13" (Sling Grws 14"-15") 9" (Sling Grws 10"-11") 190GJ7 14" (Sling Grws 15"-16") 10" (Sling Grws 11"-12") 190GJ8 15" (Sling Grws 16"-17") 11" (Sling Grws 12"-13") 190GJ9 16" (Sling Grws 17"-18") 12" (Sling Grws 13"-14") 190GJ10 17" (Sling Grws 18") 190GJ11 18" (N Grwth) 7. SEATING 190OP05 190OP04 190CU30 K0669 Seating Systems Ultra Seat Sling (Tensin Adjustable) Omit Seat Sling 1" Cushin (See matrix fr availability) $ CU1 K0669 2" Cushin (12" wide and up nly) $120 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 190JC20 Cushin Name r Part # Width (in.): Depth (in.): Price List 8. BACKREST Must cmplete Sectin A n next page 190BT96 190BU1 190BU72 Must cmplete Sectin B n next page 190BU70 190BU73 E2611 Backrest Type Flding Angle Adj. w/ Duble Lck Dwn Backrest Uphlstery Standard Uphlstery ( with Fld Dwn Push Handles) Omit Std. Uphlstery ( with Fld Dwn Push Handles) (Default when chse w/ seating) Tensin Adj. Ballistic Nyln 186BU70 ( with 8"-9" widths) Omit Tens. Adj. Ballistic Nyln $315 T rder any JAY backs n-chair, please see the JAY Price Lst. Requires Part # 190JB02 190A192 Standard Extensin 2" 190A OD20 JAY Bundled Backrest Backrest Name r Part # Width (in.) JAY Backs (Optinal) Height (in.): Backrest Handle Optin (Strller Handle) Telescping Push Handles (19" frm Seat) Telescping Push Handles - Tall (25" frm seat t push handle) Backrest Extensin Rear Backrest Extensin Brackets (4" verall) Price List 8"-10" widths have a single strller handle; mit push handle recmmended. Receiver places handle utside std. 2" extensin and inside 4" ext. Duble "D" tubing t eliminate rtatin. $215 $215 Custmer Service: Fax: rders@sunmed.cm Web: Page 2
3 SECTION A - Standard Uphlstery 1A: OMIT PUSH HANDLE OPTIONS W/ STANDARD UPHOLSTERY WHEN OMITTING UHOLSTERY 190PH2 Omit Push Handles Chse 0 r 1" Inset and Back Height 190OD5 1" inset ( 8"-9" widths) 6"- 8" Back Height 11"- 13" Back Height 6" 7" 8" 11" 12" 13" 9" - 13" Back Height 14" - 16" Back Height 9" 10" 11" 12" 13" 14" 15" 16" 13" - 17" Back Height 16" - 18" Back Height 13" 14" 15" 16" 17" 16" 17" 18" 15" - 18" Back Height 15" 16" 17" 18" 190PH6 Integral Push Handles 2A: INTEGRAL PUSH HANDLE OPTIONS W/ STANDARD UPH. Chse 0 r 1" Inset and Back Height 9"-10" Back Height 12"- 14" Back Height 9" 10" 12" 13" 14" 11" - 15" Back Height 14" - 16" Back Height 11" 12" 13" 14" 15" 14" 15" 16" 13" - 16" Back Height 16" - 18" Back Height 13" 14" 15" 16" 16" 17" 18" 15" - 18" Back Height 15" 16" 17" 18" 190OD5 1" inset ( 8"-9" widths) 190PH2 Omit Push Handles SECTION B - Tensin Adjustable Ballistic Nyln 1B: OMIT PUSH HANDLE OPTIONS W/ TENSION ADJ. Chse 0 r 1" Inset and Back Height 11"- 14" Back Height 11 "- 13" Back Height 11" 12" 13" 14" 11" 12" 13" 13" - 15" Back Height 14" - 16" Back Height 13" 14" 15" 14" 15" 16" 15" - 18" Back Height 16" - 18" Back Height 15" 16" 17" 18" 16" 17" 18" 190OD5 1" inset ( 8"-11" widths) Integral Push Handles 2B: INTEGRAL PUSH HANDLE OPTIONS W/ TENSION ADJ. Chse 0 r 1" Inset and Back Height 190OD5 1" inset ( 8"-11" widths) 9"-10" Back Height 12"- 14" Back Height 9" 10" 12" 13" 14" 11" - 14" Back Height 14" - 16" Back Height 11" 12" 13" 14" 14" 15" 16" 13" - 16" Back Height 16" - 18" Back Height 13" 14" 15" 16" 16" 17" 18" 15" - 18" Back Height 15" 16" 17" 18" 190PH5 Fld Dwn Push Handles 3B: FOLD DOWN PUSH HANDLE OPTIONS W/ TENSION ADJ. $100 Chse 0 r 1" Inset and Back Height 190OD5 1" inset ( 8"-11" widths) 11"-12" Back Height 15"- 17" Back Height 11" 12" 15" 16" 17" 13" - 16" Back Height 17" - 18" Back Height 13" 14" 15" 16" 17" 18" 15" - 18" Back Height 15" 16" 17' 18" Custmer Service: Fax: rders@sunmed.cm Web: Page 3
4 Armrest Size 190AA23 190AA18 5" 6" 7" 8" 9" 190AA AA128 With Transit, Lse 1" Seat Depth Grwth Padded Swing Away - Lw Padded Swing Away - Std. 9" 10" 11" 12" 13" 14" With Transit, Lse 1" Seat Depth Grwth, belw ptin adds 3" in Length Padded Swing Away +3" - Lw 5" 6" 7" 8" 9" Transfer Tube Length (D) Armrest - Padded Swing Away Padded Swing Away+3" - Std. 9" 10" 11" 12" 13" 14" Height Range (H) $225 $225 $ ARMRESTS $ AM22 Full Cntur 190AA29 190AA11 190AM21 190AM24 190AM23 190AM21 190AM24 Full Classic 190AM22 Full Cntur Armrest Matrix fr Single Pst and T-Pst CLASSIC PAD Pad Length (L) Desk Full 190AA AA AM23 Armrest - T-Pst Fam (see armrest matrix belw) T-Pst Fam xtra tall T-Pst Fam 2x tall Armrest - Height Adjustable (see armrest matrix belw) Cmes with std. armrest receiver nly - with 8"-9" depths Single-Pst Height Adj. Std. ( with 8"-11" depths) Desk Classic Desk Cntur Full Classic Single-Pst Height Adj. Lw. ( with 8"-9" depths) Desk Classic Desk Cntur Single Pst $210 $210 $285 $285 STD LOW 8" 5-1/4" 8" t 13" 6-1/2" t 10-1/2" 10-1/4" 14" Armrest Size Transfer Tube Length (D) CONTOUR PAD Pad Length (L) Height Range (H) Desk Full STD LOW 8" 5-1/4" 7-1/2" t 12-1/2" 6" t 10" 10-1/2" 14-1/4" Armrest - T-Pst Fam Armrest Size Xtra Tall Height Range (H) 6'' t 7'' Pad Length (L) 7-1/2'' T-Pst 2X Tall 7'' t 8'' 7-1/2'' Custmer Service: Fax: rders@sunmed.cm Web: Page 4
5 190F F F50 190F AD1 190AD2 Adaptive Platfrm 4" Spacer 190AD3 190DI08 190DI03 190DI04 190DI05 190DI07 190DI02 K0040 K0040 K0038 Aluminum Tubular Aluminum Platfrm (8" width is nly available with high munt ptin) Angle Adj. Flip Back ( with 6" caster with an 8" width) with Aluminum Tubular. Nw available with Angle Adj. Flip Back. Adaptive Platfrm 6" Spacer Extra Leg Strap Gel Hanger Cver Neprene Impact Guards Wear Pads Ftrest Aluminum Tubular w/ Snap-On Cver Adaptive Platfrm Spacers Adaptive Platfrm 2" Spacer Ftrest Optins (see matrix belw) High Munt Ext Tubes ( w/ tubular ftrest; w/ 16" wide flared frame) ** Leg Strap SEAT SLING TO FOOTREST DISTAE (based n 1" Seat Angle) * Seat t Ftrest distances may be +/- 1" frm data shwn dep. n frame type. ** High munt can adj. full range t seat sling Nte: Flip back may interfere with sling at highest settings. 10. FOOTRESTS $30 $185 $75 $40 $35 $105 $90 $50 Rear Wheel Size 3" Frnt Seat Height Matrix Frnt Caster 4" 5" 6" 14.0" 14.0" 14.5" 14.5" 15.0" 15.0" 15.0" 15.5" 15.5" 15.5" 15.5" 16.0" 16.0" 16.0" 16.0" 18" 16.5" 16.5" 16.5" 16.5" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 19.0" 19.0" 19.0" 19.0" 14.0" 14.0" 14.5" 14.5" 15.0" 15.0" 15.0" 15.5" 15.5" 15.5" 15.5" 16.0" 16.0" 16.0" 16.0" 20" 16.5" 16.5" 16.5" 16.5" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 19.0" 19.0" 19.0" 19.0" 15.5" 15.5" 15.5" 15.5" 16.0" 16.0" 16.0" 16.0" 16.5" 16.5" 16.5" 16.5" 22" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 19.0" 19.0" 19.0" 19.0" 16.0" 16.5" 16.0" 16.5" 16.0" 16.5" 16.0" 16.5" 17.0" 17.5" 17.0" 17.5" 17.0" 17.5" 17.0" 17.5" 18.0" 18.0" 18.0" 18.0" 19.0" 19.0" 19.0" 19.0" FRONT SEAT HEIGHTS ARE SHOWN IN THE BOXES ABOVE. DEPENDING ON CG SETTING, SEAT DEPTH, AND FRAME SIZE SOME OF THE ABOVE SIZES MAY NOT BE AVAILABLE Custmer Service: Fax: rders@sunmed.cm Web: Page 5
6 11. CASTERS 190CW1 190CW3 190CW31 190CW64 190CW5 190CW51 190CW6 E2219 3" Micr Caster Wheel 4" Lw-Prfile Plyurethane 4" Micr Light Up 4" x 1.5" Aluminum Sft Rll 5" Lw-Prfile Plyurethane 5" Micr Light Up 5" Sft Rll (Grey) ( with Frg Legs) $70 $185 $85 $90 190CW7 190CW66 190CW34 190CW35 190CF65 190CF69 190CF53 190CF70 5"x1.5" Semi-Pneumatic $85 5"x1.5" Aluminum Sft Rll $195 6" Ply 6"x1.5" Semi-Pneumatic $85 Caster Frks and Suspensin Multiple Psitin Multi Psitin Single Sided $125 E1015 Frg Legs lbs. $425 E1015 Frg Legs lbs. $ AXLES AND WHEELS 190AL61 Axle Plate Adjustable (COG Adjustable -0.25" thrugh 2.25" in 0.25" increments) Center f Gravity Preset 190RW12 190RW3 18" Spke ( with Spinergy, Natural Fit Handrim r Hub Lck) 20" Mag 22" Mag Mag Dependent n wheels, casters & depth 190RW103 20" Mag Wheel 5 Spke 190CC " 190RW104 22" Mag Wheel 5 Spke 190CC " (Flush w/ backrest) 190RW102 Mag Wheel 5 Spke 190CC " 190RW74 20" Lite Spke Wheel 190CC " 190RW75 22" Lite Spke Wheel 190CC " 190RW76 Lite Spke Wheel 190CC " 190RW06 22" Ultra lightweight Spke Wheel CC " 190RW10 Ultra Lightweight Spke Wheel CC " 190RW28 22" Spinergy SPOX Black Spkes 190CC " 190RW95 Spinergy SPOX Black Spkes 190CC " 190RW32 22" Spinergy LX Black Spkes 190CC " 190RW98 Spinergy LX Black Spkes 190RW8 190RW1 Rear Wheels $100 $200 $200 $200 $250 $250 $820 $820 $1,025 $1, CI1 190CI2 190CI4 190RH11 190RH12 190RH13 190RH14 190RH15 190RH16 190RH17 190RH18 190RH19 190RH26 190RH20 190RH27 190RH21 Rear Wheel 18" 20" 22" 0º 3º 15" 16" 18" Can nt exceed 2.5" drp 15.5" 16.5" 17" 17.5" 18.5" 19" Camber 6º ( with Std Mag, 5 spk MAG Wheels and Hub lcks r Side guard Hub lcks) 13" 13.5" 14" Rear Seat Height 14.5" Rear Seat Height Minimum 13.0" 13.5" 14.0" 14.5" 15.0" 15.5" 16.0" 16.5" 17.0" 17.5" 18.0" 18.5" 19.0" * With 22" & rear wheels and KIK r HP Clinchers, yu may get an additinal 1/2" lwer seat height in sme scenaris. Tire 190RT3 190RT27 190RT1 Full Ply Tire 190RT6 190RT38 190RT2 190RT21 190RT28 190RT4 E2212 E2218 E2212 E2213 E2212 E2212 Rear Wheel Tire Full Ply Tire High Pressure Clincher SHOX Perfrmance Ply Knbby V-TRAK by Kenda Pneumatic Pneumatic Airless Insert Schwalbe Marathn Plus Evlutin Schwalbe Speed Lw Ply Pneumatic Airless Insert 20",22", 20",22", 20",22", Schw albe Speed Run N/ A N/ A Spinergy N/ A N/ A High Pressure Clincher N/ A N/ A 22", 22", SHOX Perfrmance Ply Knbby V-TRAK Pneumatic Wheel Schw albe Marathn Plus Lw Ply 5 Spke Mag 20",22", 20",22", 20",22" 20",22", N/ A Mag N/ A Lite Spke 20",22", 20",22", 20",22", N/ A Ultra Lightw eight N/ A 22", 22", N/ A 22", 22", 20",22", 20",22", 22" = 489 mm = 540 mm N/ A N/ A $85 $125 Spke 18" 18" 22", Custmer Service: Fax: rders@sunmed.cm Web: Page 6
7 12. AXLES AND WHEELS (Cnt.) 13" Seat Depth 22 Rear Wheels w/ 5 Casters & 3 r 6 f Camber 0 Frame Inset Nt available in 12 r less seat depths Must have frnt seat t flr height at least 17 in the frnt and 15-1/2" in the rear. Yu can increase STFs but must keep 1-1/2 dump. If yu change camber t 0 yu can get away with 1" dump Yu must chse COG setting f -1/4. 190LK03 Hub Lck Only available with Lite Spkes; with 6º camber Seat Frame Munt (Side Guard - See Belw) Side Guard ( with Ht. Adj. Armrest r T-Pst) $100 14" Seat Depth Able t get away with 1 seat dump with a minimum f 15-1/2 in the Rear and 16-1/2 in Frnt. Can have COG set as far frward as +1/4. 190SG33 Plastic Standard ( 8"-9" depth; w/ lw padded swing aways.) 15" Seat Depth 10" Seat Depth 11" Seat Depth Able t get away with 1 seat dump with min f 15 Rear STF and 16 Frnt STF COG can be adjusted as far frward as Rear Wheels w/ 4 Casters, 3 r 6 f Camber, and 0 Frame Inset Nt available in 8 r 9 seat depths. Must have at least a 15 Rear STF and 16 Frnt STF. COG setting must be -1/4. If yu increase Rear STF t 15-1/2 and 16-1/2 Frnt STF yu can mve COG t 0. If yu increase the dump t 1 ½ (15 R-STF and 16 1/2 F-STF) r change Camber t 0 degress yu can increase COG t 1/4. Same as 10" Seat Depth, just allws yu t have COG setting a 1/4 12" Seat Depth Must have at least 15 Rear STF and 15-1/2 Frnt STF. COG setting can be as far frward at 1/2. If yu increase the dump t 1 instead f 1/2" yu can increase COG as far frward as Rear Wheels w/ 4 Casters, 3 r 6 Camber, and 0 Frame Inset Nt available in 10 seat depths r less. 190SG29 190SG7 190SG37 190SG38 190GE01 190GE02 190GE03 Plastic Lw ( 8"-9" depth; w/ Padded Swing Aways lw setting 5&6) Aluminum Flding Aluminum w/ Fender & Hub Lck (Pull t lck - single hand R-side munt) ( with seat frame munt hub lck) Aluminum w/ Fender & Hub Lck (Pull t lck - single hand L-side munt) ( with seat frame munt hub lck) Aluminum Side Guard Clr Optin Only available with Aluminum Side Guard Black Matching Frame - Std. Clrs Matching Frame - Custm Clr $185 $275 $275 $50 11" Seat Depth 12" Seat Depth Must have at least a 16 Rear STF and 17 Frnt STF. COG setting can be 0 r -1/4. Must have at least 16 Rear STF and 17 Frnt STF. COG setting can be as far frward as 1. (Camber must be 3 degrees) If camber is 6 than COG can nly be as far frward as 3/4" 190AT1 1908A20 E0971 E0971 Rear Anti-Tips Anti-Tip Dynamic Center Rear Caster Dynamic Center Rear Caster $295 Handrim Wheel Lck 190HR1 Aluminum Andized 190WL1 High Munt Push 190HR4 Plastic Cated ( n Ultra) $ WL2 High Munt Pull 190HR22 190HR23 190HR30 Natural Fit -Standard Grip ( n Ultra Lite, 20" Lite Spke r 20" and 22" 5 spk MAG) Natural Fit - Super Grip ( n Ultra Lite, 20" Lite Spke r 20" and 22" 5 spk MAG) Natural Fit LT - Standard Grip ( n Ultra Lite, 20" Lite Spke r 20" and 22" 5 spk MAG) $395 $425 $ WL30 190WL10 190EH1 E0961 Cmpact Omit Wheel Lck Extensin Handle 6" Pair $75 Natural Fit LT - Super Grip 190HR31 ( n Ultra Lite, 20" Lite Spke r 20" and 22" $475 5 spk MAG) 190HR24 Spinergy Flex Rim (Only n Spinergy LX) $ HR7 Omit Handrim (Only n Mag, 24 Spinergy) Axle 190AX1 Quick Release Steel Custmer Service: Fax: rders@sunmed.cm Web: Page 7
8 13. ACCESSIES Back Pack (Kids Backpack included) 190A1 Utility Backpack - Black $75 190A2 190A8 Additinal Kids Black Backpack Black Seat Puch $60 $50 Nt available with 5 spke MAG wheels 190A23 K0065 Black $115 Miscellaneus 190A203 E2207 Crutch Hlder $195 Upper Extremity Supprt Tray 190A83 Tl Kit Psitining Belt (w/ clamps) $45 190A29 190A30 190A31 E0950 E0950 E0950 X-Sm (Suggested 10"-12" Width) Sm (Suggested 13"-14" Width) Med (Suggested 15"-17" Width) $255 $255 $ A112 E0978 1" Dual Pull Side Squeeze Padded $85 190A32 E0950 Lrg (Suggested 18"-20" Width) $ A117 E0978 Belt 2" Aircraft Buckle $ A A A A120 E0978 E0978 E0978 K0108 Belt 2" Aircraft Buckle Padded $ A303 Additinal Optins Thrugh Built-4-Me Belt 1.5" Aut Buckle w/ clamps $70 T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) 1" Cmfrt Fit APB5116 $ , Fax: (800) Psitining Belt Side Clamp $50 K0065 Spke Guard Spke Guards Clear Zippie ( with Spinergy) Cmmnly Requested Optins Include: Aluminum Seat Pan Swing Away Knee Aductr Height Adjustable Strller Handle Remvable Strller Handle Custm Paint and Andizing $115 Sunrise Medical (US) LLC 2842 Business Park Ave. Fresn, CA USA Custmer Service: Fax: rders@sunmed.cm Web: Page 8
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a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Email: Cnfirm Via: ZIP: Quickie QRi January 2019 EIR
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a Mark Submitting Fr: fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirmatin Email: Cnfirm Via: PO#: Quickie Q7 Active
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