Quickie GTX Fixed Frame EIF3, Effective July 2009

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Jonah Caldwell
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1 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 on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy. BASE MODEL FRAME TYPE SEAT WIDTH K0005 Quickie GTX- Fixed Frame W/C $1, Please note: The J3 Back is not available with 12" or 13" frame widths. 163S3 12" NC Not available with Jay Precision Backs 163FS9 K0005 Standard NC 163S4 13" NC 250 Lbs. Max Wt Limit Not available with Jay Precision Backs 163FS30 Heavy Duty $ S5 14" NC Lbs. Max Wt Limit 163S6 15" NC Requires Stabilizer Bar 163S7 16" NC NA with -1" or -2" Back Depth Adj. or Xtender Power Assist 163S8 17" NC 163S9 18" NC FRAME ANGLE 163S10 19" NC 75 o Fixed Front Frame NC 163S11 E " $ o Fixed Front Frame NC SEAT DEPTH FRAME INSET (PER SIDE) 163SD5 12" NC 163FF1 0" NC 163SD6 13" NC 163FF2 1" NC 163SD7 14" NC Not available with 12" or 13" wide frames 163SD8 15" NC 163SD9 16" NC FRAME COLOR 163SD10 17" NC 163C2 Black NC 163SD11 18" NC 163C10 Black Opal NC 163SD12 19" NC 163C1 Blue NC Not available with -1" or -2" Back Depth Adjustment 163C38 Blue Opal NC 163SD13 E " $ C12 Blue Velvet NC Not available with -1" or -2" Back Depth Adjustment 163C36 Candy Blue NC 163SD14 E " $ C35 Candy Red NC Not available with -1" or -2" Back Depth Adjustment 163C39 Candy Turquoise NC 163SD30 E " $ C6 Forest Green NC Not available with -1" or -2" Back Depth Adjustment 163C4 Midnight Purple NC 163C37 Orange NC 163C5 Pearl Pink NC 163C40 Razzleberry NC 163C11 Toxic Green NC 163C8 Yellow NC 163C43 Mossy Oak Camouflage $ C42 Stars & Stripes $ SEAT WIDTH / SEAT DEPTH MATRIX Page 1 of 5

2 Quickie GTX Fixed Frame, November 2008 FRONT SEAT HEIGHT XTENDER POWER ASSIST ACCESSORIES 163SH14 16" NC 163XA1 Xtender Spare Nimh Power Pack $1, SH " NC Manual Wheel Add-On Accessory Pkg for Xtender Only 163SH16 17" NC 163XA2 24" Spoke Pneu Alum Handrim NC 163SH " NC 163XA3 24" Spoke Pneu w/airless Alum Hand $ SH18 18" NC 163XA4 24" Spoke Pneu Plastic Handrim $ SH " NC 163XA5 24" Spoke Pneu w/airless Plast Hand $ SH21 19" NC 163SH " NC BACK TYPE 163SH24 20" NC 163BT3 Folding Backrest NC 163SH " NC 163BT1 Non-Folding Backrest NC 163SH27 21" NC BACKREST HEIGHT REAR SEAT HEIGHT 163B110 10" To 14" Back Height NC Size Rear STFH Range Size Rear STFH Range 20" RW 12"-16.5" 22" RW 13"-17.5" 24" RW 14"-18.5" 24" (559) RW 14.5"-19" 26" RW 15"-19.5" CUSHION 163RH9 12" NC BACKREST UPHOLSTERY 163B127 12" To 16" Back Height NC 163B111 14" To 18" Back Height NC 163B137 16" To 20" Back Height NC 163RH " NC 163BU1 Standard Upholstery NC 163RH11 13" NC 163BU8 Adjustable Upholstery $ RH " NC Not available with fabric side guards 163RH13 14" NC 163BU57 Vented Adjustable Upholstery $ RH " NC 163BU14 Omit Back Upholstery -$ RH15 15" NC Jay J3 Back 163RH " NC Please see the J3 Back order form for part #'s. 163RH17 16" NC To order a J3 Back please select Omit Back Upholstery. 163RH " NC Please note: The J3 Back requires back canes or push ha 163RH19 17" NC 163BU34 E0956 Jay Precision Back Med w/laterals $ RH " NC May interfere with some armrest heights 163RH20 18" NC Not available with 12" and 13" seat width 163RH " NC 163BU35 E0956 Jay Precision Back Tall w/laterals $ RH21 19" NC May interfere with some armrest heights 163RH " NC Not available with 12" and 13" seat width 163BU41 Jay Precision Back Med w/o Laterals $ Not available with 12" and 13" seat width To order any of the following JAY cushions on-chair, please see the on-chair order form. 163BU42 Jay Precision Back Tall w/o Laterals $ JC01 Jay Basic See OF Not available with 12" and 13" seat width 163JC02 Jay Easy See OF 163KE22 E1028 Lateral Pad Symmetric Swing Away $ JC03 Jay Soft Combi P See OF Should additionally billed as E JC04 Jay J2 See OF 163KE20 E0956 Lateral Pad Symmetric $ JC05 Jay J2 DC See OF 163KE19 E0956 Lateral Pad Asymmetric $ JC06 Jay Lite See OF 163KE21 E1028 Lateral Pad Asymmetric Swing Away $ SL6 Omit Seat Sling -$15.00 Should additionally billed as E CU1 2" Cushion $95.00 XTENDER POWER ASSIST Only available with 24" wheels and 0 o camber. BACKREST OPTIONS 163PH6 Integral Push Handles NC HD Frames require Integral Push Handles and Stabilizer B 163XT1 E0986 Xtender Power Assist $6, PH5 Fold-Down Push Handles $90.00 XTENDER POWER ASSIST HANDRIM Rear Seat Height Range 17.5"-19.5" for Xtender. Not available with 10"-14" Back Height or Standard Uphols NA with HD Frame. Center of Gravity Range 1", 0, -.5" 163PH2 Omit Push Handles NC Not available with Padded S/A arms 163SZ1 Stabilizer Bar $ Stabilizing Bar required with HD Frame Style Only available with Integral Push Handles You must choose one of the following torque options. 163SZ2 Folding Stabilizer Bar $ XH1 3x Torque Multiplier (Plastic Coated) NC Stabilizing Bar required with HD Frame Style 163XH2 1.5x Torque Multiplier (Stainless Steel) NC Only available with Integral Push Handles XTENDER POWER ASSIST TIRE HEADREST 163XW2 E2213 Xtender Airless Tire $ HE1 E0955 Curved Headrest 8" X 4.5" $ XW1 Xtender Pneumatic Tire NC Available only with Folding Stabilizer Bar 163HE2 E0955 Curved Headrest 9" X 4.5" $ Available only with Folding Stabilizer Bar Page 2 of 5

3 Quickie GTX Fixed Frame, July 2008 BACK DEPTH ADJUSTMENT CASTER OPTIONS 163BG1 Standard non adjustable NC 163OC1 K0073 Caster Pin Locks $ BG2-1" $ Not available with Frog Legs NA with HD Frame or 19"-22" deep seats, Omit Back Uph. 163BG3-2" $ CASTER FORK SUSPENSION NA with HD Frame or 19"-22" deep seats, Omit Back Uph. 163CF53 E1015 Frog Legs 0# weight to 100# $ CF54 E1015 Frog Legs 101# weight to 190# $ FOOTPLATE 163CF55 E1015 Frog Legs 191# weight to 250# $ F245 Tubular Flip Up NC 163F246 Tubular Flip Up w/ ABS Cover NC CASTER INTERFERENCE MATRIX 163F247 Platform Angle Adj Flip Up $ F248 High Mount Plat. Angle Adj Flip Up $ Not available with12" or 13" Seat Width and 1" Frame Inset 163F249 K0040 Split Platform Angle Adj Flip Away $ Split Platform footrest NA with 12" wide frame or 14" wide with 1" inset 163F250 Auto Folding Angle Adj $ Not to be used by double amputee FOOTREST OPTIONS 163A179 Positioning Plates $50.00 ARMREST - PADDED SWING-AWAY Not available with Auto Folding Angle Adj footrest 163AA16 Padded Swing-Away Adult $ AA20 Padded Swing-Away Adult Long $ AA17 Padded Swing-Away Kids $ AR6 Standard Hardware NC 163AR5 Angle Adjustable Hardware $50.00 Tubular/Flat Autofold Platform Split Inset Inset Inset Inset 0" 1" 0" 1" 0" 1" 0" 1".5".5".5" 2" 1" 1" 1" NA Soft Roll 1" 1" 1" NA 1" 2" 1" NA 2".5" NA.5" 2".5" NA.5" 2" 1" NA 1" 2" 1" NA 1" 1" 1" 1" 1" 1.5" 1.5" 1.5" 1.5" 2".5" 2".5" 2".5" NA.5" NA 1.5" NA 1.5" NA 1.5" NA 1.5" NA 1.5" NA 1.5" NA 1.5" NA 1.5" Soft Roll NA 1.5" NA 1.5" NA 1.5" NA 1.5" NA 2" NA 2" NA 2" NA 2" NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA = Go # = "Soft" Go with limited seat angles NA = No-Go Min seat angle listed in cell AXLE SPACING ARMREST - HEIGHT ADJUSTABLE 163AV7.75" NC 163AA8 E0973 Single Post Height Adjustable - Adult $ Not available with plastic sideguards Requires minimum axle spacing of 1 //2" Not available with 0 o Camber 163AM1 Desk Length (10") NC 163AV2 1" NC 163AM2 Full Length (14") NC Not available with plastic sideguards 163AA9 E0973 Single Post Height Adjustable - Kids $ AV6 1.25" NC Requires minimum axle spacing of 1 //2" Not available with plastic sideguards 163AM1 Desk Length (10") NC 163AV3 1.5" NC 163AM2 Full Length (14") NC 163AV8 1.75" NC 163AA86 E Point Height Adjustable $ Only available with Adjustable Upholstery (Non Vented) CAMBER 163AM1 Desk Length NC 163CI1 0 o NC 163AM2 Full Length NC 16317CI 2 o NC Not available with Xtender Power Assist. CASTERS 163CI3 4 o NC 85 Frame Angle 75 Frame Angle 163CW1 3" Micro NC Not available with Xtender Power Assist. 163CW30 3" Micro Lighted $ CW3 4" Low Profile Polyurethane NC REAR WHEEL SIZE 163CW31 4" Micro Lighted $ RW3 20" Mag Wheel NC 163CW47 E2219 4" x 1.5" Semi Pneumatic $ RW8 22" Mag Wheel NC Available only with Frog Legs 163RW1 24" Mag Wheel NC 163CW5 5" Low Profile Polyurethane NC 163RW4 20" Spoke Wheel $ CW51 5" Micro Lighted $ RW9 22" Spoke Wheel $ CW6 5" Soft Roll $ RW2 24" Spoke Wheel NC Not available with Frog Legs 163RW11 26" Spoke Wheel $ CW7 E2119 5" x 1.5" Semi Pneumatic $ RW77 22" Ultra Lightweight Spoke Wheel $ CW34 6" Poly NC Available with silver anodized aluminum handrim 163CW35 E2219 6" x 1.5" Semi Pneumatic $85.00 and high pressure clincher tire REAR WHEEL SIZE CONTINUED ON NEXT PAGE Caster Size 3" 4" 5" 6" 3" 4" 5" 6" Fork Page 3 of 5

4 Quickie GTX Fixed Frame, July 2009 REAR WHEEL SIZE (CONTINUED) AXLE PLATE 163RW78 24" Ultra Lightweight Spoke Wheel $ C 163AL40 $45.00 Available with silver anodized aluminum handrim C 163AL36 Standard NC and high pressure clincher tire 163AL37 E0959 Amputee $ RW80 26" Ultra Lightweight Spoke Wheel $ AL39 Xtender NC Available with silver anodized aluminum handrim 163AL38 Rear Suspension $ and high pressure clincher tire 163RW50 24" Mountain Wheel $ REAR WHEEL/TIRE MATRIX 163RW19 24" HT BB Spoke Wheel (559) $ Wheel 163RW23 24" HT Tnns Spoke Wheel (559) $ RW26 26" HT BB Spoke Wheel $ RW22 26" HT Tnns Spoke Wheel $ RW30 24" Spinergy (540) SPOX Black Spokes $ RW42 24" Spinergy (540) SPOX Yellow Spokes $ RW43 24" Spinergy (559) SPOX Black Spokes $ Full Poly Tire 20,22,24 20,22,24 163RW31 24" Spinergy (559) SPOX White Spokes $ RW44 26" Spinergy (590) SPOX Black Spokes $ RW24 26" Spinergy (590) SPOX Yellow Spokes $ RW88 24" Spinergy (540) LX Black Spokes $ RW89 24" Spinergy (559) LX Black Spokes $ REAR SUSPENSION WEIGHT RATING Rear Wheel & Tire Matrix Tire Mag Spoke Ultra Light Quickie HT Spinergy Mountain Pneumatic 20,22,24 20,22,24,26 24,26 Pneumatic Airless Insert 20,22,24 20,22,24 24 Mountain Tire 24 Kevlar Latex Tubular 24,26 25 High-Pressure Clincher 22,24,26 22,24,26 24,25,26 Turbo Tread 25,26 Schwalbe Marathon Plus Evol ,25 Kik Mako Black ,25 24 = = = RW49 Omit Rear Wheel & Axles X-tender NC 163SV04 From 0# weight to100# NC Only available with Xtender 163SV05 From 101# weight to190# NC 163SV06 From 191# weight to 250# NC REAR WHEEL TIRE 163RT1 Pneumatic NC CENTER OF GRAVITY (CG) PRESET 163RT2 E2213 Pneumatic Airless Insert $ CC11-1" NC 163RT12 Mountain Tire NC NA with Fixed, Standard or Amputee Axle Plate 163RT8 Kevlar $ CC10 -.5" NC 163RT7 Latex Tubular NC NA with Fixed or Standard Axle Plate 163RT3 Full Poly Tire NC 163CC12 0" NC 163RT6 High-Pressure Clincher $95.00 NA with Fixed or Standard Axle Plate 163RT5 Turbo Tread NC 163CC1.5" NC 163RT21 Schwalbe Marathon Plus Evolution $95.00 NA with Fixed or Xtender Axle Plate 163RT22 Kik Mako Black $ CC2 1" NC NAwith Fixed Axle Plate HANDRIM 163CC3 1.5" NC 163HR1 Aluminum Anodized NC NA with Fixed or Xtender Axle Plate 163HR4 Plastic Coated $ CC4 2" NC 163HR22 Natural Fit Standard Grip $ NA with Fixed or Xtender Axle Plate NA on Quickie HT, Mountain Wheels, or Ultra Lightweight 163CC5 2.5" NC 163HR23 Natural Fit Super Grip $ NA with Xtender Axle Plate NA on Quickie HT, Mountain Wheels, or Ultra Lightweight 163CC6 3" NC 163HR7 Omit Handrim -$10.00 NA with Fixed or Xtender Axle Plate 163HR9 8 Vertical Projections $ CC7 3.5" NC NA with Xtender Axle Plate 163HR8 8 Oblique Projections $ CC8 4" NC NA with Xtender Axle Plate 163HR11 12 Vertical Projections $ CC9 4.5" NC NA with Fixed, Standard or Amputee Axle Plate 163HR10 12 Oblique Projections $ CC13 5" NC NA with Fixed or Xtender Axle Plate AXLE WHEEL LOCK 163AX1 Quick Release Steel NC 163WL1 High Mount Push NC 163AX11 Quad Quick Release $ WL2 High Mount Pull NC NA with Spinergy Wheels or Ultra Lightweight Wheels 163WL27 Ergo Scissor NC 163AX5 Titanium $ WL29 Compact $ NA with Spinergy Wheels or Ultra Lightweight Wheels 163WL24 Unilateral Push Lock Right Mount $ Only available with Performance HT Wheels Not available with Grade Aids or Extension Handles 163AX16 Titanium Quad $ WL23 Unilateral Push Lock Left Mount $ NA with Spinergy Wheels or Ultra Lightweight Wheels Not available with Grade Aids or Extension Handles Only available with Performance HT Wheels 163WL10 Omit Wheel Lock NC 163WL12 Do Not Mount NC Page 4 of 5

5 Quickie GTX Fixed Frame, July 2009 EXTENSION HANDLE MISCELLANEOUS Not available with Ergo Scissors, Throw, or Unilateral Wheel Locks 163A82 Caddy $ EH1 E0961 6" Pair $ A87 Travel Wheels $ EH2 E0961 6" Right $30.00 Not available with Xtender Power Assist 163EH3 E0961 6" Left $30.00 Not available with Heavy Duty Frame 163IG20 Impact Guards $85.00 GRADE AID 163A51 E2207 Crutch Holder $ GA1 E0974 Grade Aid $ A83 Tool Kit NC NA w/ Ergo Scissor, Throw, or Unilateral Wheel Locks 163A27 Touch Up Paint $25.00 NA with polyurethane or high pressure clincher tires 163A32 E0950 Wheelchair Tray $ A54 K0038 Xtra Leg Strap $30.00 REAR ANTI-TIP 163A96 Presta Valve Adapter $ AT1 E0971 Rear Anti-Tip $ AT53 E0971 Rear Anti-Tip- Swing Away $ AT3 Omit Rear Anti-Tip NC BACKPACK 163A1 Black Utility Backpack $ A2 Black/Charcoal Kids $50.00 SEAT POUCH 163A8 Black $45.00 SPOKE GUARD NA with Spinergy Wheels or Ultra Lightweight Wheels 163A23 Black $ A24 Clear $ POSITIONING BELT 163A12 E0978 Belt 2" Aircraft Buckle $ A13 E0978 Belt 2" Aircraft Buckle Padded $ A142 E0978 Belt 1-1/2" Auto Buckle Universal $70.00 SIDE GUARD 163SG1 Fabric Regular $45.00 NA with Adjustable or Vented Upholstery 163SG2 Fabric Kids $45.00 NA with Adjustable or Vented Upholstery 163SG3 Plastic Regular $ SG4 Plastic Kids $ SG15 Aluminum $ SG13 Aluminum with Fender $ SG12 Carbon Fiber with Fender $ Page 5 of 5

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