Kimba Neo. Paediatric postural positioning system. Base price Outdoor mobility base: EUR x,xxx. Base price Seating unit: EUR x,xxx
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- Rosalind Warner
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1 Base price Outdoor mobility base: EUR x,xxx Base price Seating unit: EUR x,xxx valid from 1/1/2016 to 31/12/2016 Provide estimate only Order Order no.: Kimba Neo Paediatric postural positioning system Maximum load capacity of the outdoor mobility base: 55 kg (including seating unit) Article number 470G71=10000_K Maximum load capacity of the seating unit: 40 kg Article number 470G71=20000_K Attachment for custom fabrication enclosed Billing address/customer number Ottobock KimbaNeo_647F411=EN Technical modifications and printing errors reserved Delivery address Sales person Name... Date Signature Picture includes accessories Standard equipment Outdoor mobility base Folding outdoor mobility base made of highgrade aluminium Rear axle suspension Push bar with ratchet joint, height-adjustable Folding storage bag EVA wheels with wheel lock Integrated anchor points for mounting to wheelchair accessible vehicle Seating unit Seat width, seat depth, back height and lower leg length are continuously adjustable Seat inclination, back and knee angle continuously adjustable Seat tilt continuously adjustable up to 30 Quick-release mechanism to remove the seat/position the seat in/against the direction of travel Footrest assembly with flip-up footplate Lateral side supports Adjustable hip supports Kimba Neo 1/8
2 Outdoor mobility base Standard KA 01 Size 1 (from approx. 1 to 6 years) KA 05 Size 2 (from approx. 4 to 10 years) Outdoor mobility base is used with: (please specify) Kimba Neo seating unit, size 1 Kimba Neo seating unit, size 2 Kimba Spring seating unit, size 1 Kimba Spring seating unit, size 2 Squiggles seating unit Mygo seating unit, size 1 Lars car seat, size 1 Lars car seat, size 2 Other seating unit for adapter, size 1 Other seating unit for adapter, size 2 Front wheels KF 01 Rigid (only possible for size 1) KF 02 Swivelling (with integrated swivel lock) Tyres KF 03 EVA KF 04 Pneumatic Rear wheel type KG 01 Standard KG 02 With drum brake (for attendant) Frame colour 001 Silver metallic 013 Jet black RAL 9005 matte Kimba Neo 2/8
3 Seating shell interface KC 03 Kimba KB 01 Footrest assembly for seating shell interface Accessories for outdoor mobility base KS 08 Backpack, attaches to push bar KA 07 Bumpers, pair KS 03 Techno buggy board KS 04 Diaper bag, brown* KS 06 Diaper bag, black* KS 07 Cup holder KA 10 KA 11 Platform for respiratory devices** (only possible with swivelling front wheels) Pre-mounted position: Seat installation in direction of travel Platform for respiratory devices** (only possible with swivelling front wheels) Pre-mounted position: Seat installation against direction of travel KA 08 Tip-assist, left KA 12 Tip-assist, right * Includes extensive accessories such as changing mat, pacifier pouches, insulated bag for bottles and a plastic utensil pouch as well as numerous compartments and zip pockets ** Please also note the information on page 7. Seating unit Standard KC 01 Size 1 (approx. 1 to 6 years) KC 02 Size 2 (approx. 4 to 10 years) Kimba Neo 3/8
4 Seating unit is used with: (please specify) Other mobility base size 1 Other mobility base size 2 Kimba Neo outdoor mobility base size 1 Kimba Neo outdoor mobility base size 2 Kimba Cross size 1 Kimba Cross size 2 Kimba Inline Indoor mobility base, size 1, anthracite Indoor mobility base, size 2, anthracite Squiggles Hi Low chassis (for Kimba Neo seat, size 1) Mygo Hi Low chassis (for Kimba Neo seat, size 2) discovery tmax kids (for Kimba Neo seat, size 2) Frame colour 001 Silver metallic 013 Jet black RAL 9005 matte Padding 1 KD 00 Without Price reduction 905 Spacer fabric beige/brown Spacer fabric beige/green 1 KD 09 Microfibre grey/berry 1 KD 21 Microfibre grey/blue 1 KD 22 Microfibre black/berry 1 KD 23 Microfibre black/blue 1 Back insert KD 01 Standard KD 02 With integrated headrest Footrest KB 03 Standard KB 05 Angle-adjustable Kimba Neo 4/8
5 Accessories footrest KB 08 Slip resistant footrest cover 1 KB 09 Padding for footrest KB 06 Foot straps, pair KB 07 Hook-and-loop foot straps with instep pad Accessories seating unit KD 03 Headrest supports 1 (in padding colour) KD 04 Thoracic supports 1 (in padding colour) KP 02 Lap belt, padded 1, 2 KP 03 Four-point belt 1, 2, padded KP 05 Five-point belt, small buckle (recommended for seat, size 1) KP 04 Five-point belt, large buckle KP 06 Groin strap KP 10 Fixation vest 1, 2 KP 11 Chest and shoulder support, size 1 KP 12 Chest and shoulder support, size 2 KP 13 Chest and shoulder support, size 3 KP 15 Padded pull tight paedriatric belt KP 16 Shoulder harness size S KP 17 Shoulder harness size M Kimba Neo 5/8
6 KQ 01 Grip bar KQ 02 Padding for grip bar (in padding colour) KQ 03 Grip bar with PVC cover KE 01 Armrests KC 06 KC 07 KC 08 Abductor, size 1 1 (L 9 cm W 6 cm H 9 cm), only for seat, size 1, in padding colour Abductor, size 2 1 (L 10 cm W 7.5 cm H 10 cm), in padding colour Abductor, size 3 1 (L 12 cm W 9 cm H 10 cm), only for seat, size 2, in padding colour KD 10 Lumbar support padding KD 11 Neck support KS 01 Tray, grey (to be used in direction of travel only) KS 02 Tray, transparent (to be used in direction of travel only) KD 12 Incontinence cover 1 KW 01 Summer/winter slipsack, size S KW 02 Summer/winter slipsack, size M KW 03 Summer/winter slipsack, size L KS 08 Backpack, attaches to push bar Kimba Neo 6/8
7 KS 04 Diaper bag, brown* KS 06 Diaper bag, black* KS 07 Cupholder KW 04 Rain cape, grey KW 05 Canopy in padding colour, incl. adapter 1 and rain cover (In case of microfibre covers, the base colour of the canopy is black.) KW 06 Rain canopy, transparent, with cover for the legs, includes adapter 1 KP 01 Chosen accessories installed (only for accessories marked with 1 ) In case more than one options marked with ² ordered only one position will be mounted. KC 10 Seat depth shortener KD 20 Back angle limitation Mounting of mountingset (fixation of clamb buckle on KP 14 the backrest etc.) * Includes extensive accessories such as changing mat, pacifier pouches, insulated bag for bottles and a plastic utensil pouch as well as numerous compartments and zip pockets. Special options Maxi Cosi adapter MP Seat I and II according to Pörnbach MP Slipsack in special colours MP Tray attachment on tray MP Footrest padding 5 cm MP Platform for respirator, long MP (max. load capacity 55 kg with driving brake and wheel lock) Seat adapter 8.5 cm higher (transport in wheelchair accessible vehicle is not allowed for size 1 and size 2) MP Grab rail, straight, angle-adjustable MP Padding for grab rail, angle-adjustable MP Tray attachment on tray (grey) extended by 15 cm (in height) MP Kimba Neo 7/8
8 Information Storage space for respirator platform, Kimba Neo size 1 (in cm) Seat in direction of travel Seat against direction of travel L W H Large plate: Small plate: Storage space for respirator platform, Kimba Neo size 2 (in cm) Seat in direction of travel Seat against direction of travel L W H Large plate: Small plate: Kimba Neo 8/8
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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
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:
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
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
For the Modulite Teen seating please select the underlined options on this form and include a completed Modulite Teen Seating form
Power Wheelchair Retail Prescription Form BORAMOD111217 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2018 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Customer Ref : Account
CONTENT. Rehab buggies Rehab strollers Seating and positioning products Chassis and frames Specialty products
Division REHA EN CONTENT Rehab buggies Rehab strollers Seating and positioning products Chassis and frames Specialty products Rehab buggies FULLY ADJUSTABLE CORZO Xcountry SEMI ADJUSTABLE CORZINO Xcountry
Canada Quote / Order Form Combi
Canada Quote / Order Form Combi 7105 Northland Terrace Brooklyn Park, MN 55428 Ph# 1-888-538-6872- Ext 2 Fax# 763-582-0442 Amy Jorgensen-Inside Sales AmyJ@danetechnologies.com www.levousa.com Dealer Information
Invacare Kite (Modulite Flex3 Seating System) Dealer Max User Weight 160Kg (25 stone)
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
Invoice address: same as company address. Invoice address: other (see below) Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact:
Im Hofstätt 11 D- 72359 Dotternhausen Tel +49 (0)7427 9480-0 Fax +49 (0)7427 9480-7025 e-mail info@proactiv-gmbh.de www.proactiv-gmbh.de Quotation date: Order date: according to GTC PRO ACTIV GmbH TRAVELER
k-series Aluminium Standard Features
Manual Wheelchair Retail Prescription Form KSeries200618 Tel: 01656 776222 Fax: 01656 776220 Email: ordersuk@invacare.com Online spares available at: www.invacare.co.uk July 2018 Customer Ref: Account
MODEL ICHAIR MC3 CHARACTERISTICS, POTENCY AND BENEFITS
MODEL 1.612 ICHAIR MC3 CHARACTERISTICS, POTENCY AND BENEFITS ECONOMICAL Simple maintenance. The high grade of servicing friendliness makes it very economical Long life and high end components Modular system
R82 Kudu - E1233. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features:
Account #: Purchase Order No.: Contact: R82 Kudu - E1233 CAD Retail Price List/ Order Form Date: Mark For: Bill To: Address: City/State/Zip: Phone: Email Ship To: Address: City/State/Zip: Phone: Kudu Standard
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:
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
Manufacturer: Model: Seat width: cm Seat depth: cm
Thompson House Unit 10, Styles Close, Sittingbourne, Kent ME10 3BF Tel: 01795 477280 Fax: 01795 229692 Email: sales@rms-kent.co.uk web: www.ineedawheelchair.co.uk Caddy modular seating system order form
M1 - NPO. Dealer Information. Client Information. Client Measurements
Dealer Information * Contact: Dealer Code: * Dealer Name: Address: * City: * Province: * Phone#: * Fax#: PO#: Email Address: Client Information Permobil recommends that the client is evaluated by a certified
Please choose the seat width for accessories: 35 cm 40 cm 43 cm 45 cm 50 cm
Netti 4U comfort fully adjustable Date Invoice address Invoice address = delivery address Customer code C- Contact person Reference Other delivery address Offer Order Basic price: 2.750,- excl. VAT. Seat
Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg
QUICKIE IRIS Invoice to: Deliver to: Name: Name: Street: Street: Town: Postal code: Town: E-Mail: E-Mail: Tel: Fax: Tel: Order date: Marked for: Purchase order: Number required: Sunrise order no: Base
Bracket for control unit as attendant control:
Accessories Bracket: Combination of mechanical attachment for drive wheels and distributor for power supply and control signals. Please include in order, if not present Please indicate wheelchair type
[ ] Quote [ ] Order. Junior US Retail Price List. Account Information. Ship To Information. Standard Features.
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Account Information Date Account Number Branch Dealer Contact Phone Fax Email Address PO Number Mark For Ship To Information [ ] Quote [ ] Order Shown with Optional Equipment Standard Features Name Address