C300 TS VR Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements
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1 list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal code: City: Country: Phone: Client Measurements Weight: Height: 1) Upper leg length: 2) Chest Depth: 3) Seat pan to elbow: 4) Arm pit height: 5) Top of shoulders: 6) Top of head: 7) Elbow to Hand: 8) Chest width: 9) Knee to Foot: 10) Hip width: kg All specifications and prices are subject to change without notice. Please note that displayed prices are only valid if ordered with the wheelchair. Any parts ordered for service or future alterations will carry different prices and warranty. Rabobank Parkstad Limburg Rekening: IBAN: NL84RABO BIC/SWIFT: RABONL2U Permobil Europe B.V. De Doom 22 NL 6419 CX HEERLEN Phone: +31 (0) Fax: +31 (0) Page 1 of 5
2 Chassis Model C300 VR2 ADV WITH TS-SEAT EUR 4, C300 VR2 BASIC WITH TS-SE AT EUR 4, Colour covers COVER BLACK ONYX C300 EUR COVER COBALT BLUE C300 EUR COVER DEEP PURPLE C300 EUR COVER PHANTOM GRAY C300 EUR COVER POPSTAR PINK C300 EUR COVER VOLCANO RED C300 EUR - Cover inserts LID KIT COVER C300 EUR - Hub cap HUB CAP BLACK ONYX INCL R EFLECTOR EUR HUB CAP COBALT BLUE INCL REFLECTOR EUR HUB CAP DEEP PURPLE INCL REFLECTOR EUR HUB CAP PHANTOM GRAY INCL REFLECTOR EUR HUB CAP POPSTAR PINK INCL REFLECTOR EUR HUB CAP VOLCANO RED INCL REFLECTOR EUR - Front wheels WHEELS 3.00x8" AIR FILLED TIRES EUR WHEELS 3.00x8" SOLID TIRES EUR WHEEL " MUD/SNOW AIR TIRE (1 pair) EUR Accessoires chassis Batteries BATTERIES, 60Ah, SET OF 2 EUR WITHOUT BATTERIES EUR - Charger CHARGER PERMOBIL 24V/8A EU EUR WITHOUT CHARGER EUR - Light kit LIGHT KIT WITH FRONT INDI CATOR C300/K300 VR2 EUR REFLECTOR KIT C300/K300 EUR - Chassis adaption for Permolock C3 (+) ADAPT C300/350 FOR PERMOLOCK C3 EUR Rain cover (+) TARPAULIN/RAINCOVER FOR ALL MODLES EUR Seat assembly Seat lift system SEAT ELEVATOR C300 VR2 EUR 1, SEAT ELEVATOR FOR SEAT TI LT C300 VR2 EUR 1, SEAT TUBE FIXED TS C300/C350 EUR - Seat tilt options POWERED ADJ.SEAT TILT 30 TS EUR 1, FIXED SEAT ANGEL TS EUR - Seat Seat SEAT TS C300 C350 EUR - Seat depth (+) MOUNTING POSITION SEAT DEPTH 360mm TS EUR MOUNTING POSITION SEAT DEPTH 410mm TS EUR MOUNTING POSITION SEAT DEPTH 460mm TS EUR MOUNTING POSITION SEAT DEPTH 510mm TS EUR - Page 2 of 5
3 Seat depth (+) MOUNTING POSITION SEAT DEPTH 560mm TS EUR - Seat width (+) MOUNTING POSITION SEAT WIDTH 380mm TS EUR MOUNTING POSITION SEAT WIDTH 430mm TS EUR MOUNTING POSITION SEAT WIDTH 480mm TS EUR MOUNTING POSITION SEAT WIDTH 530mm TS EUR - Seat options SOLID SEAT PLATE WITHOUT CUSHION EUR SEAT "SLING SEAT" INCL. CUSHION EUR SEAT "SLING SEAT" INCL. CUSHION EUR - Backrest BACKREST SLING BACK LONG 380x430 INCL. CUSHION EUR BACKREST SLING BACK LONG 480x530 INCL. CUSHION EUR BACKREST SLING BACK SHORT 430x450 INCL. CUSHION EUR BACKREST SLING BACK SHORT INCL. CUSHION EUR BACKREST WITHOUT SLING BACK EUR - Strap extensions (+) STRAP EXTENSION LONG BACK REST TS EUR STRAP EXTENSION SHORT BACKREST TS EUR - Adjustment backrest MANUAL CONTROL BACKREST TS EUR POWER CONTROL BACKREST C300/C350 TS EUR Legrest LEGREST CENTER MOUNTED MANUAL ADJUSTABLE EUR LEGREST CENTER MOUNTED POWERED ADJUSTABLE EUR 1, LEGRESTS SWING AWAY TS EUR - Armrest leveling support / reinforcement (+) ARMRESTS PARELLEL MOVING EUR Accessories seat Headrest (+) HEAD SUPPORT "ERGO" (REQUIRES PUSH HANDLES) EUR Backrest extension (+) BACKREST EXTENSION KIT TS EUR Lateral support (+) LATERAL SUPPORTS SMALL(A) 150x140 TEXTILE (MESH) EUR LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR LATERAL SUPPORTS MED(F) 220x90 TEXTILE (MESH) EUR Thigh support (+) THIGH SUPPORTS TEXTILE (MESH) 200x90 LARGE (C) EUR THIGH SUPPORTS TEXTILE (MESH) 165x120 MEDIUM (J) EUR THIGH SUPPORTS TEXTILE (MESH) 110x90 SMALL (B) EUR THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR Calf support (+) CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR Seatbelt (+) BELT 2-POINT LARGE NONPAD BODYPOINT INCL BRACK UT EUR BELT 2-POINT LARGE PADDED BODYPOINT INCL BRACK UT EUR BELT 2-POINT MEDIUM NONPA D BODYPOINT INCL BRACK UT EUR BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR SAFETY BELT,AUTOTENSION LONG VERSION EUR SAFETY BELT,BUCKLE EUR SAFETY BELT,AUTOTENSION EUR Mounting position seatbelt (+) MOUNT POS SEATBELT ROLL RIGHT EUR MOUNT POS SEATBELT ROLL LEFT EUR - Push handles back (+) PUSH HANDLES TS EUR Page 3 of 5
4 Stump support (+) STUMP SUPPORT LARGE (H) 170x175 TEXTILE (MESH) EUR STUMP SUPPORT MEDIUM (J) 165x120 TEXTILE (MESH) EUR STUMP SUPPORT SMALL (A) 150x140 TEXTILE (MESH) EUR STUMP SUPPORT XLARGE (D) 200x200 TEXTILE (MESH) EUR Support handles set (+) SUPPORT HANDLES SET (pair) C 3G EUR Support handle armrest (+) SUPPORT HANDLE ARMREST TS JR EUR Table adjust angel (+) TABLE,ANGLE ADJUST. 1-SIDE FIXATION EUR Table small for armrest mount (+) TABLE SMALL ARMREST MOUNT -ED TS JR EUR Crutch holder (+) CRUTCH HOLDER TS EUR Holder oxygen bottle (+) HOLDER OXYGEN BOTTLE TS EUR User control User control JOYSTICK VR2 BASIC WIHOUT SEAT/LIGHT BUTTONS EUR JOYSTICK VR2 ADVANCED WITH SEAT/LIGHT BUTTONS EUR - Joystick holder PANELHOLDER VR2/R-NET STD L=335 EUR PANELHOLDER VR2/R-NET L=435 EUR PANEL HOLDER CENTRAL STEE RING EUR PANELHOLDER PAR. SW. AWAY VR2/R-NET L/R EUR WITHOUT PANELHOLDER EUR - Mounting position joystick (+) MOUNT POS CONTROLBOX LEFT EUR MOUNT POS CONTROLBOX RIGHT EUR - Attendant control Attendant control (+) JOYSTICK ATTENDANT VR2 EUR Permolock Permolock C3 (+) PERMOLOCK C3 WITH STANDARD SWITCH EUR User manual Permolock (+) USER MANUAL DK PERMOLOCK C3 EUR USER MANUAL EU PERMOLOCK C3 EUR USER MANUAL FI PERMOLOCK C3 EUR USER MANUAL FR PERMOLOCK C3 EUR USER MANUAL DE PERMOLOCK C3 EUR USER MANUAL NL PERMOLOCK C3 EUR USER MANUAL IT PERMOLOCK C3 EUR USER MANUAL NO PERMOLOCK C3 EUR USER MANUAL PT PERMOLOCK C3 EUR USER MANUAL ES PERMOLOCK C3 EUR USER MANUAL SE PERMOLOCK C3 EUR USER MANUAL US PERMOLOCK C3 EUR - Release lever (+) MANUAL RELEASE FOR PERMOLOCK C EUR Quicklock holder release lever (+) QUICKLOCK HOLDER RELEASE LEVER EUR Spacer kit (+) Page 4 of 5
5 Spacer kit (+) SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) PERMOLOCK SNAP IN KIT EUR Car Seat adapter (+) CAR SEAT ADAPTER PERMOLOCK C3 EUR Wheel spacer (+) WHEEL BUMP FOR PERMOLOCK C3 EUR Extension cable Permolock (+) EXTENSION CABLE FOR PERMOLOCK C,C3 EUR Chair Order Policy: For other options and special adaptations, please call Permobil for further details. Please also refer to Permobil s Delivery Policy for further information. Your order cannot be processed without the following: - The client s name - The client s measurements - The client s weight For your ordering, please sign below with date and company stamp. Signature: Date: Company Stamp: An order confirmations will be provided by Permobil summarizing the items selected. Please review this carefully. Page 5 of 5
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list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
C350 PS VR2. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements
list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
C300 Corpus VR2. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements
list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
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list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
C350 Corpus VR2 Advanced
list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
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C350 Corpus 3G R-Net. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements
list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal
C500(S) Corpus 3G R-Net
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Dealer Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm
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Canada Quote / Order Form Combi
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x:panda, size 1, med. back X c x:panda, size 1, med. seat 7¼" X c
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QUICKIE TANGO... 5 BASE FRAME... 5 BATTERY BOX... 5 COVERS... 6 MAIN FRAME... 7 MOTOR MOUNT & ANTI TIP... 8 SUSPENSION... 9 MOTOR...
Title - 1 - Title - 2 - Table Of Contents QUICKIE TANGO... 5 BASE FRAME... 5 BATTERY BOX... 5 COVERS... 6 MAIN FRAME... 7 MOTOR MOUNT & ANTI TIP... 8 SUSPENSION... 9 MOTORS... 10 MOTOR... 10 SEAT/BACK...
Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm
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ALEX QLASS. Order form. T: +44 (0) F: +44 (0)
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PRESCRIPTION FORM. Delivery address. Purchase order. Shipment date Delivery Date. Type
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Phone: Nov-17
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Product Catalogue
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Order form LEVO LAE 2011/1
Seat height 48 Seat height 51 Seat height 54 Seat height 57 Order form LEVO LAE 2011/1 Please answer the following questions exactly and consider the indications.the exact measurement within the pictograms
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Please choose the seat width for accessories: 35 cm 40 cm 43 cm 45 cm 50 cm
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Assembly Product name Item no. Version
MANUAL WHEELCHAIRS 1 Sideguard 1 2 6 3 4 7 8 9 1 1 470019 Sideguard left, complete pc. 2 1 470018 Sideguard right, complete pc. 3 1 420013 Sideskirt black, left pc. 4 1 420012 Sideskirt black, right pc.
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BEARINGS BEARINGS
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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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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
Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.
AADL W659/W991 Quantum Q6 Edge Z with TB3 Power Positioning FOR AADL USE ONLY Pride Mobility Products Co. 5096 South Service Rd, Beamsville, ON, L0R 1B3 Phone: 888-570-1113 Fax: 866-514-1303 Discount:
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20080301 Product Catalog 2008 www.permobil.com Contents C300...3 Accessories, C300 chassis...4 C400...5 Accessories, C400 chassis...6 C500...7 Accessories, C500 chassis...8 Street...9 Hexior...10 X850...11
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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.072318 Shipping Address * * required F r a
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Invacare Ltd Power Prescription Form Pencoed Technology Park Dealer Prescription Form Pencoed CF35 5AQ LPF1U2KITEFLEX011015Dealer Tel: +44 (0) 1656 776222 Fax: +44 (0) 1656 776220 July 2015 email: ordersuk@invacare.com
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Orderform UK / IR Valid from Version 2.1 LUCA QLASS. Date:
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This product is available for purchase online at www.mypride.com Account #: Date: Order No. Fax No. Phone No. PAGE 1 Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA 18643 Sales: Phone:
The order form has (MSRP) retail prices, but your price is at least 25% less than retail price. Multiply retail by.75 or call or for a quote.
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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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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
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Title - 1 -
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