M5 Corpus. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements

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Vanessa Lawrence
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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:

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 14

2 Chassis Model M5 R-NET WITH CORPUS-SEAT EUR 8, _Esp module (+) ESP UNIT R-NET INCL CABLE EUR Accent colour covers COVER KIT GALACTIC GREEN M5 EUR COVER KIT MIDNIGHT BLACK M5 EUR COVER KIT OCEAN BLUE M5 EUR COVER KIT PHANTOM GREY M5 EUR COVER KIT POWER PINK M5 EUR COVER KIT RADIANT RED M5 EUR COVER KIT SUNBURST ORANGE M5 EUR COVER KIT TITAN BLUE M5 EUR - Front wheels WHEEL 3.00X8 MUD/SNOW AIR TIRE BLACK EUR WHEEL 3.00x8" BLACK AIR W ITH SPACER EUR WHEEL 3.00x8" BLACK SOLID WITH SPACER EUR - Caster wheels WHEEL KIT AIR 210X65 BLAC K EUR WHEEL KIT SOLID 210X65 BL ACK EUR - Accessories chassis Batteries BATTERIES, 73Ah, SET OF 2 EUR WITHOUT BATTERIES EUR - Charger CHARGER PERMOBIL 24V/8A EU EUR WITHOUT CHARGER EUR - Light kit LIGHT KIT FOR LUGGAGE BOX M3/M5 EUR LIGHT KIT STD M3/M5 EUR REFLECTOR KIT C300/K300 EUR - Luggage carrier (+) LUGGAGE BOX EUR LUGGAGE BOX REFLECTOR EUR _Light kit Combination (+) REAR LIGHTS ON CHASSIS AN D LUGGAGE BOX EUR - Remote stop (+) REMOTE STOP WITH BRAKET EUR Rain cover (+) TARPAULIN/RAINCOVER FOR ALL MODLES EUR Seat assembly Seat elevator (powered elevator requires powered seat tilt) SEAT ELEVATOR EUR 2, SEAT TUBE FIXED EUR 0.01 Seat tilt options SEAT TILT 50 EUR 2, SEAT TILT FIXED EUR 0.01 Mounting position seat (-10, -20 and -45 require powered seat tilt) SEAT MOUNT ANTERIOR -10 EUR SEAT MOUNT ANTERIOR -20 EUR SEAT MOUNT ANTERIOR -5 EUR SEAT MOUNT HORIZONTAL EUR - Page 2 of 14

3 Seat Seat width SEAT WIDTH 420 (17") EUR SEAT WIDTH 470 (19") EUR SEAT WIDTH 520 (21") EUR SEAT WIDTH 570 (23") EUR 0.01 Seat depth SEAT DEPTH 370mm (14") EUR SEAT DEPTH 395mm (15") EUR SEAT DEPTH 420mm (16") EUR SEAT DEPTH 445mm (17") EUR SEAT DEPTH 470mm (18") EUR SEAT DEPTH 495mm (19") EUR SEAT DEPTH 520mm (20") EUR SEAT DEPTH 545mm (21") EUR SEAT DEPTH 570mm (22") EUR 0.01 Seat cushion SEAT CUSHION 420x370mm (1 7"x15") LEATHERETTE EUR SEAT CUSHION 420x370mm (1 7"x15") MESH EUR SEAT CUSHION 420x420 (17" x17") LEATHERETTE EUR SEAT CUSHION 420X420 (17" x17") MESH EUR SEAT CUSHION 420x470 (17" x19") LEATHERETTE EUR SEAT CUSHION 420x470 (17" x19") MESH EUR SEAT CUSHION 420x520 (17" x21") LEATHERETTE EUR SEAT CUSHION 420x520 (17" X21") MESH EUR SEAT CUSHION 420x570mm (1 7"x23") LEATHERETTE EUR SEAT CUSHION 420x570mm (1 7"x23") MESH EUR SEAT CUSHION 470x370mm (1 9"x15") LEATHERETTE EUR SEAT CUSHION 470x370mm (1 9"x15") MESH EUR SEAT CUSHION 470x420 (19" x17") LEATHERETTE EUR SEAT CUSHION 470x420 (19" x17") MESH EUR SEAT CUSHION 470x470mm (1 9"x19") LEATHERETTE EUR SEAT CUSHION 470x470mm (1 9"x19") MESH EUR SEAT CUSHION 470x520mm (1 9"x21") LEATHERETTE EUR SEAT CUSHION 470x520mm (1 9"x21") MESH EUR SEAT CUSHION 470x570mm (1 9"x23") LEATHERETTE EUR SEAT CUSHION 470x570mm (1 9"x23") MESH EUR SEAT CUSHION 520x420 (21" x17") LEATHERETTE EUR SEAT CUSHION 520x420 (21" x17") MESH EUR SEAT CUSHION 520x470mm (2 1"x19") LEATHERETTE EUR SEAT CUSHION 520x470mm (2 1"x19") MESH EUR SEAT CUSHION 520x520mm (2 1"x21") LEATHERETTE EUR SEAT CUSHION 520x520mm (2 1"x21") MESH EUR SEAT CUSHION 520x570mm (2 1"x23") LEATHERETTE EUR SEAT CUSHION 520x570mm (2 1"x23") MESH EUR SEAT CUSHION 570x470mm (2 3"x19") LEATHERETTE EUR SEAT CUSHION 570x470mm (2 3"x19") MESH EUR SEAT CUSHION 570x520mm (2 3"x21") LEATHERETTE EUR SEAT CUSHION 570x520mm (2 3"x21") MESH EUR SEAT CUSHION 570x570mm (2 3"x23") LEATHERETTE EUR SEAT CUSHION 570x570mm (2 3"x23") MESH EUR WITHOUT SEAT CUSHION C 3G EUR Ergo support seat (+) THIGH SUPPORT ERGO (L/R) EUR - Adjustment backrest MAN. CONTROL BACKREST REC LINE CORPUS LA28 EUR POWER CONTROL BACKREST 15 0 RECLINE CORPUS LA28 EUR 1, POWER CONTROL BACKREST RE CLINE 180 CORPUS LA28 EUR 1, Backrest Fixed/Bio-mech BACKREST FIXED C 3G EUR BACKREST SHEERING C 3G EUR Page 3 of 14

4 Backrest BACKREST SHORT W 360 x H 470 EUR BACKREST SHORT W 410 x H 470 EUR BACKREST SHORT W 460 x H 470 EUR BACKREST SHORT W 510 x H 470 EUR BACKREST W 360 x H EUR BACKREST W 410 x H EUR BACKREST W 460 x H EUR BACKREST W 510 x H EUR DIRECT BACKREST ADAPTER EUR TUBULAR BACKREST FRAME EUR WITHOUT BACKREST CORPUS EUR - Backrest height (+) BACKREST HEIGHT 545 C 3G EUR BACKREST HEIGHT 570 C 3G EUR BACKREST HEIGHT 595 C 3G EUR BACKREST HEIGHT 620 C 3G EUR BACKREST HEIGHT 645 C 3G EUR BACKREST HEIGHT 670 C 3G EUR - Backrest cushion BACKREST CUSHION 360x480 (14"x19") MESH BLACK C 3G EUR BACKREST CUSHION 360x480 (14"x19") SKAI C 3G EUR BACKREST CUSHION 360x (14"x22-24") MESH BLA EUR BACKREST CUSHION 360x (14"x22-24") SKAI EUR BACKREST CUSHION 360x (14"x25-27") MESH BLA EUR BACKREST CUSHION 360x (14"x25-27") SKAI EUR BACKREST CUSHION 410x480 (16"x19") MESH BLACK C 3G EUR BACKREST CUSHION 410x480 (16"x19") SKAI C 3G EUR BACKREST CUSHION 410x (16"x22-24") MESH BL EUR BACKREST CUSHION 410x (16"x22-24") SKAI EUR BACKREST CUSHION 410x (16"x25-27") MESH BLA EUR BACKREST CUSHION 410x (16"x25-27") SKAI EUR BACKREST CUSHION 460x480 (18"x19") MESH BLACK EUR BACKREST CUSHION 460x480 (18"x19") SKAI C 3G EUR BACKREST CUSHION 460x (18"x22-24") MESH BLA EUR BACKREST CUSHION 460x (18"x22-24") SKAI EUR BACKREST CUSHION 460x (18"x25-27") MESH BLA EUR BACKREST CUSHION 460x (18"x25-27") SKAI EUR BACKREST CUSHION 510x480 (20"x19") MESH BLACK C 3G EUR BACKREST CUSHION 510x480 (20"x19") SKAI BLACK C 3G EUR BACKREST CUSHION 510x (20"x22-24") MESH BL EUR BACKREST CUSHION 510x (20"x22-24") SKAI BL EUR BACKREST CUSHION 510X (20"x25-27") MESH BL EUR BACKREST CUSHION 510x (20"x25-27") SKAI BL EUR WITHOUT BACKREST CUSHION C 3G EUR Ergo support back (+) LATERAL SUPPORT LARGE (ERGO) C 3G EUR LATERAL SUPPORT SMALL (ERGO) C 3G EUR - _Armrest kit NEW ARMREST NARROW EUR ARMREST WIDE EUR - Width between armrests MOUNT POS BETWEEN ARMREST 380mm C 3G EUR MOUNT POS BETWEEN ARMREST 430mm C 3G EUR MOUNT POS BETWEEN ARMREST 480mm C 3G EUR MOUNT POS BETWEEN ARMREST 530mm C 3G EUR MOUNT POS BETWEEN ARMREST 580mm C 3G EUR - Armrest height adjustment ARMREST HEIGHT POS 1: 230 mm/9" EUR ARMREST HEIGHT POS 2: 255 mm/10" EUR ARMREST HEIGHT POS 3: 280 mm/11" EUR ARMREST HEIGHT POS 4: 305 mm/12" EUR - Page 4 of 14

5 Armrest height adjustment ARMREST HEIGHT POS 5: 330 mm/13" EUR - Armrest holder ARMREST ASSEMBLY FIXED C 3G EUR ARMREST ASSEMBLY SWIVELL- ING C 3G EUR Armrest Left ARMREST 260 (10") LEFT EUR ARMREST 335 (13") LEFT EUR ARMREST 410 (16") LEFT EUR ARMREST 460 (18") LEFT EUR WITHOUT ARMREST LEFT C 3G EUR _Armrest upholstry Left (+) ARMREST PAD FABRIC 260 (1 0") LEFT EUR ARMREST PAD FABRIC 335 (1 3") LEFT EUR ARMREST PAD FABRIC 410 (1 6") LEFT EUR ARMREST PAD FABRIC 460 (1 8") LEFT EUR ARMREST PAD LEATHERETTE 2 60 (10") LEFT EUR ARMREST PAD LEATHERETTE 3 35 (13") LEFT EUR ARMREST PAD LEATHERETTE 4 10 (16") LEFT EUR ARMREST PAD LEATHERETTE 4 60 (18") LEFT EUR ARMREST PAD STEALTH GEL 2 60 (10") LEFT EUR ARMREST PAD STEALTH GEL 3 35 (13") LEFT EUR ARMREST PAD STEALTH GEL 4 10 (16") LEFT EUR ARMREST PAD STEALTH GEL 4 60 (18") LEFT EUR Armrest Right ARMREST 260 (10") RIGHT EUR ARMREST 335 (13") RIGHT EUR ARMREST 410 (16") RIGHT EUR ARMREST 460 (18") RIGHT EUR WITHOUT ARMREST RIGHT C 3 G EUR _Armrest upholstry Right (+) ARMREST PAD FABRIC 260 (1 0") RIGHT EUR ARMREST PAD FABRIC 335 (1 3") RIGHT EUR ARMREST PAD FABRIC 410 (1 6") RIGHT EUR ARMREST PAD FABRIC 460 (1 8") RIGHT EUR ARMREST PAD LEATHERETTE 2 60 (10") RIGHT EUR ARMREST PAD LEATHERETTE 3 35 (13") RIGHT EUR ARMREST PAD LEATHERETTE 4 10 (16") RIGHT EUR ARMREST PAD LEATHERETTE 4 60 (18") RIGHT EUR ARMREST PAD STEALTH GEL 2 60 (10") RIGHT EUR ARMREST PAD STEALTH GEL 3 35 (13") RIGHT EUR ARMREST PAD STEALTH GEL 4 10 (16") RIGHT EUR ARMREST PAD STEALTH GEL 4 60 (18") RIGHT EUR Adjustment legrest MAN. CONTROL LEGREST CORP US LA28 EUR POWER CONTROL LEGREST M5 CORPUS LA28 EUR 1, POWER CONTROL LEGREST M5 CORPUS PWR EXT LEG LA28 EUR 1, WITHOUT ADJUSTMENT LEGRES T C3G EUR - Legrest LEGREST LONG EXTENSION (2 05mm) CORPUS 3G EUR LEGREST PWR ADJ LONG EUR 2, LEGREST PWR ADJ SHORT EUR 2, LEGREST PWR EXTENSION (200mm) EUR 2, LEGREST SHORT EXTENSION ( 185mm) CORPUS EUR WITHOUT LEGREST C 3G EUR - Footplate FOOTPLATE 1PCS CORPUS 3G EUR FOOTPLATE NARROW (160mm) EUR FOOTPLATE NARROW (160mm) LONG LEG ( ) EUR FOOTPLATE NARROW (160mm) LONG LEG ( ) C 3G EUR FOOTPLATE NARROW (160mm) SHORT LEG ( ) EUR 0.01 Page 5 of 14

6 Footplate FOOTPLATE NARROW (160MM) SHORT LEG ( ) C 3G EUR FOOTPLATE ONE PIECE LONG LEG ( ) EUR FOOTPLATE ONE PIECE SHORT LEG ( ) EUR FOOTPLATE WIDE (200mm) LONG LEG ( ) EUR FOOTPLATE WIDE (200mm) LONG LEG ( ) C 3G EUR FOOTPLATE WIDE (200mm) SHORT LEG ( ) EUR FOOTPLATE WIDE (200mm) SHORT LEG ( ) C 3G EUR FOOTPLATES WIDE 200mm (8" ) HD EUR WITHOUT FOOTPLATES EUR - Combined back/leg (+) ICS PROGRAMS FOR VS & C3G LINKS LEGS TO BACK MOVEM EUR - _Virtual Seating Coach (+) VIRTUAL SEATING COACH KIT INCL PHONE HOLDER EUR VIRTUAL SEATING COACH KIT INCL TABLET HOLDER EUR - Accessories seat Headrest (+) HEADREST ERGO FABRIC CORP US 3G EUR HEADREST ERGO SHORT BACK FABRIC CORPUS 3G EUR HEADREST FABRIC CORPUS 3G EUR HEADREST L LONG ARM EUR HEADREST L LONG ARM SHORT BACKREST EUR HEADREST L STD ARM EUR HEADREST L STD ARM SHORT BACKREST EUR HEADREST LEATHERETTE CORP US 3G EUR HEADREST M LONG ARM EUR HEADREST M LONG ARM SHORT BACKREST EUR HEADREST M STD ARM EUR HEADREST M STD ARM SHORT BACKREST EUR HEADREST S LONG ARM EUR HEADREST S LONG ARM SHORT BACKREST EUR HEADREST S STD ARM EUR HEADREST S STD ARM SHORT BACKREST EUR HEADREST SHORT BACK FABRI C CORPUS 3G EUR HEADREST SHORT BACK SKAI CORPUS 3G EUR STEALTH COMFORT PLUS 8" H EADREST PAD EUR STEALTH COMFORT PLUS MEDI UM 10" HEADREST PAD EUR Headrest holder for Stealth headrest (+) STEALTH HEADREST HARDWARE - 1" BALL, SHORT 6" POST EUR Lateral facial support left for Steath headrest (+) STEALTH 900 FACIAL LATERA L PAD - LEFT EUR STEALTH 910 FACIAL LATERA L PAD - LEFT EUR STEALTH 920 FACIAL LATERA L PAD - LEFT EUR Lateral facial support right for Steath headrest (+) STEALTH 900 FACIAL LATERA L PAD FOR COMFORT PLUS EUR STEALTH 910 FACIAL LATERA L PAD FOR COMFORT PLUS EUR STEALTH 920 FACIAL LATERA L PAD FOR COMFORT PLUS EUR Lateral support left (+) LATERAL SUPPORT LARGE 180 x130mm LEFT EUR LATERAL SUPPORT LEFT MOD A C3G FABRIC EUR LATERAL SUPPORT LEFT MOD E C3G FABRIC EUR LATERAL SUPPORT LEFT MOD F C3G FABRIC EUR LATERAL SUPPORT SMALL 130 x80mm LEFT EUR Lateral support right (+) LATERAL SUPPORT LARGE 180 x130mm RIGHT EUR LATERAL SUPPORT RIGHT MOD A C3G FABRIC EUR LATERAL SUPPORT RIGHT MOD E C3G FABRIC EUR LATERAL SUPPORT RIGHT MOD F C3G FABRIC EUR LATERAL SUPPORT SMALL 130 x80mm RIGHT EUR Page 6 of 14

7 Thigh support left (+) THIGH SUPPORT LEFT MOD B FABRIC EUR THIGH SUPPORT LEFT MOD C FABRIC EUR THIGH SUPPORT LEFT MOD G FABRIC EUR THIGH SUPPORT LEFT MOD J FABRIC EUR Thigh support right (+) THIGH SUPPORT RIGHT MOD B FABRIC EUR THIGH SUPPORT RIGHT MOD C FABRIC EUR THIGH SUPPORT RIGHT MOD G FABRIC EUR THIGH SUPPORT RIGHT MOD J FABRIC EUR Hip support left (+) HIP SUPPORT LEFT MOD A FA BRIC EUR HIP SUPPORT LEFT MOD B FA BRIC EUR HIP SUPPORT LEFT MOD C FA BRIC EUR HIP SUPPORT LEFT MOD D FA BRIC EUR Hip support right (+) HIP SUPPORT RIGHT MOD A F ABRIC EUR HIP SUPPORT RIGHT MOD B F ABRIC EUR HIP SUPPORT RIGHT MOD C F ABRIC EUR HIP SUPPORT RIGHT MOD D F ABRIC EUR Calf support (+) CALF REST (B) 110x90 FABR IC EUR CALF REST (J) 165x120 FAB RIC EUR CALF REST A 150x140 FAB- RIC C 3G EUR CALF REST B 110x90 FABRIC C 3G EUR CALF REST D 200x200 FAB- RIC C 3G EUR CALF REST H 170x175 (CONTOUR) FABRIC C 3G EUR CALF REST J 165x120 FABRIC C 3G EUR CALFREST (A) 150x140 FAB RIC HD EUR CALFREST (D) 200x200 FAB RIC HD EUR CALFREST (H) 170x175 FAB RIC HD EUR Elbow support left (+) STEALTH ELBOW SUPPORT WIT H 3" x 10" PAD - LEFT EUR SUPPORT ARMREST ASSEMBLY ELBOW STOP - LEFT EUR Elbow support right (+) STEALTH ELBOW SUPPORT WIT H 3" x 10" PAD - RIGHT EUR SUPPORT ARMREST ASSEMBLY ELBOW STOP - RIGHT EUR Support armrest outside Left (+) SIDE SUPPORT ARMREST ASSE MBLY LEFT OUTSIDE EUR Support armrest outside Right (+) SIDE SUPPORT ASSEMBLY ARM REST EUR Support armrest inside Left (+) SIDE SUPPORT ASSEMBLY ARM REST LEFT INSIDE EUR Support armrest inside Right (+) SIDE SUPPORT ASSEMBLY ARM REST RIGHT INSIDE EUR Gel pads footplates (+) STEALTH GEL PADS NARROW FOOTPLATES (PAIR) EUR STEALTH GEL PADS WIDE FOO TPLATES EUR Knee support (+) KNEESTOP STD CORPUS EUR Knee support holder (+) HOLDER KNEESUPP UNITRACK EUR Chest strap (+) CHEST STRAP BODYPOINT ELA STIC LARGE EUR CHEST STRAP BODYPOINT ELA STIC SMALL 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 Page 7 of 14

8 Seatbelt (+) BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR BELT, HIP 2-PT, PADDED LARGE BODYPOINT EUR SAFETY BELT,AUTOTENSION LONG VERSION EUR SAFETY BELT,BUCKLE EUR SAFETY BELT,4-POINT EUR SAFETY BELT,AUTOTENSION EUR Mounting position Seatbelt roll (+) MOUNT POS SEATBELT ROLL RIGHT EUR MOUNT POS SEATBELT ROLL LEFT EUR - Abduction wedge (+) ABDUCT WEDGE CORPUS 3G EUR Wedge backrest (+) WEDGE NARROW BACKREST C 3 G EUR WEDGE STD BACKREST C 3G EUR WEDGE WIDE BACKREST C 3G EUR WEDGE BACKREST 510 W EUR Seat Cushion Corpus Ergo Air (+) SEAT CUSHION CORPUS ERGO AIR 420x370 (17"x15") EUR SEAT CUSHION ROHO 420x420 (17"x17") EUR SEAT CUSHION ROHO 420x470 (17"x19") EUR SEAT CUSHION ROHO 420x520 (17"x21") EUR SEAT CUSHION CORPUS ERGO AIR 420x570 (17"x23") EUR SEAT CUSHION CORPUS ERGO AIR 470x370 (19"x15") EUR SEAT CUSHION ROHO 470x420 (19"x17") EUR SEAT CUSHION ROHO 470x470 (19"x19") EUR SEAT CUSHION ROHO 470x520 (19"x21") EUR SEAT CUSHION ROHO 520x420 (21"x17") EUR SEAT CUSHION ROHO 520x470 (21"x19") EUR SEAT CUSHION ROHO 520x520 (21"x21") EUR Support handles set (+) SUPPORT HANDLES SET (pair) C 3G EUR 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 Mounting position stump support (+) MOUNT POS AMPUTATION SUPP -ORT LEFT EUR MOUNT POS AMPUTATION SUPP -ORT RIGHT EUR - Push handles back (+) PUSH HANDLES C 3G EUR PUSH HANDLES C 3G NARROW BACKREST EUR Table Swing able (+) TABLE SWING AWAY CENTER MOUNTED R-NET C 3G 600 EUR TABLE SWING AWAY CENTER MOUNTED R-NET C 3G 650 EUR TABLE SWING AWAY SIDE CUT R-NET C 3G 600 EUR TABLE SWING AWAY SIDE CUT R-NET C 3G 650 EUR Mounting position table (+) MOUNT POS TABLE SWINGABLE LEFT EUR MOUNT POS TABLE SWINGABLE RIGHT EUR - Table adjust angel (+) TABLE ADJUSTABLE ANGLE 350mm C 3G EUR TABLE ADJUSTABLE ANGLE 400mm C 3G EUR TABLE ADJUSTABLE ANGLE 450mm C 3G EUR TABLE VARIABLE ANGLE EUR _Bracket Table (+) BRACKET ADDITIONAL POSITI ON TABLE ADJ EUR Table small for armrest mount (+) TABLE SMALL LEFT MOUNT C 3G EUR Page 8 of 14

9 Table small for armrest mount (+) TABLE SMALL RIGHT MOUNT C 3G EUR Incontinence protection (+) INCONTINENCE PROTECTION 4 20x370 (17"x15") EUR INCONTINENCE PROTECTION 4 20x420 17"x17" EUR INCONTINENCE PROTECTION 4 20x470 17"x19" EUR INCONTINENCE PROTECTION 4 20x520 17"x21" EUR INCONTINENCE PROTECTION 4 20x570 (17"x23") EUR INCONTINENCE PROTECTION 4 70x370 (19"x15") EUR INCONTINENCE PROTECTION 4 70x420 19"x17" EUR INCONTINENCE PROTECTION 4 70x470 19"x19" EUR INCONTINENCE PROTECTION 4 70x520 19"x21" EUR INCONTINENCE PROTECTION 4 70x570 19"x23" EUR INCONTINENCE PROTECTION 5 20x420 21"x17" EUR INCONTINENCE PROTECTION 5 20x470 21"x19" EUR INCONTINENCE PROTECTION 5 20x520 21"x21" EUR INCONTINENCE PROTECTION 5 20x570 21"x23" EUR INCONTINENCE PROTECTION 5 70x470 23"x19" EUR INCONTINENCE PROTECTION 5 70x520 23"x21" EUR INCONTINENCE PROTECTION 5 70x570 23"x23" EUR Armrest pouch Right (+) ARMREST POUCH BLACK RIGHT EUR - Armrest pouch Left (+) ARMREST POUCH BLACK LEFT EUR - Seat frame pouch (+) ARMREST POUCH BLACK CENTE R MOUNTED EUR Bag hooks (+) BAG HOOKS OPEN UNITRACK EUR Back pack (+) BACK PACK EUR Foot straps (+) FOOTSTRAPS WITHOUT PADS EUR FOOTSTRAPS WITH PADS EUR Lumbar support (+) LUMBAR SUPPORT,AIR EUR Crutch holder (+) CRUTCH HOLDER C 3G EUR Mount. pos. crutch holder (+) MOUNT POS CRUTCH HOLDER LEFT EUR MOUNT POS CRUTCH HOLDER RIGHT EUR - Holder oxygen bottle (+) OXYGEN HOLDER C 3G EUR Cup holder (+) SELF LEVELING CUP HOLDER EUR Cellphone holder (+) X-GRIP PHONE HOLDER EUR Tablet holder (+) TABLET HOLDER RAM X-GRIP WITH BRAKET EUR User control User control CONTROL PANEL LED R-NET EUR CONTROL PANEL R-NET CJSM2 EUR JOYSTICK 3.5" COLOR DISPL AY WITH BLUETOOTH EUR JOYSTICK COMPACT ADV. R-NET EUR JOYSTICK R-NET CJSM HEAVY DUTY EUR NON STANDARD STEERING EUR - _Table steering (+) Page 9 of 14

10 _Table steering (+) TABLESTEERING R-NET FLIP- OVER PANEL C 3G 600 EUR 1, TABLESTEERING R-NET FLIP- OVER PANEL C 3G 650 EUR 1, Parameters Disbale JS Menu Memory Recall (+) SOFTWARE DISABLE SEAT MEMORIES RECALL VIA JS EUR - Parameters Disbale JS Menu Memory Save (+) SOFTWARE DISABLE SEAT MEMORIES SAVE VIA JS EUR - Parameters Disbale JS Menu Seat Functions (+) SOFTWARE DISABLE SEAT POSITIONING VIA JS EUR - Joystick holder (+) PANEL HOLDER CENTRAL STEE RING EUR PANEL HOLDER PARALLEL MOTION UNITRACK EUR WITHOUT PANELHOLDER EUR - Panel holder bracket C 3G (+) PANEL HOLDER BRACKET C 3G EUR - Height adjustable holder (+) HEIGHT ADJUSTABLE JOYSTIC K BRACKET CLAMP EUR HEIGHT ADJUSTABLE JOYSTIC K BRACKET LEFT EUR HEIGHT ADJUSTABLE JOYSTIC K BRACKET RIGHT EUR Mounting position joystick (+) MOUNT POS CONTROLBOX LEFT EUR MOUNT POS CONTROLBOX RIGHT EUR - Mounting centre steering (+) MOUNT POS TABLE STEERING FLIPOVER LEFT EUR MOUNT POS TABLE STEERING FLIPOVER RIGHT EUR - Switch box SWITCH BOX WITH PUSH BUTTONS EUR SWITCH BOX WITH TOGGLE SWITCHES EUR WITHOUT SWITCH BOX EUR - Bracket switch box (+) BRACKET SWITCH BOX BACK CORPUS 3G EUR BRACKET SWITCH BOX JOYSTICK EUR BRACKET SWITCH BOX UNITRACK ARMREST EUR - Mounting position switch box (+) MOUNT POS SWITCH KIT LEFT EUR MOUNT POS SWITCH KIT RIGHT EUR SWITCHBOX NOT MOUNTED EUR - Layout switch box (+) SWITCHBOX LAYOUT "A" EUR SWITCHBOX LAYOUT "B" EUR SWITCHBOX LAYOUT "C" EUR SWITCHBOX LAYOUT "D" EUR SWITCHBOX LAYOUT "E" EUR SWITCHBOX LAYOUT "F" EUR LAYOUT "L" SWITCH BOX EUR - Indication level switch box (+) SWITCHBOX INDICATION LEVEL 1 EUR SWITCHBOX INDICATION LEVEL 2 EUR SWITCHBOX INDICATION LEVEL 3 EUR SWITCHBOX INDICATION LEVEL 4 EUR - External charger socket (+) CHARGER SOCKET EXTERNAL MOUNTED ON ACC. RAIL EUR CHARGER SOCKET EXTERNAL MOUNTED ON THE ARMREST EUR CHARGER SOCKET EXTERNAL MOUNTED UNDER SEAT FRAME EUR Mounting position charger socket (+) MOUNT POS CHARGER SOCKET LEFT EUR MOUNT POS CHARGER SOCKET RIGHT EUR - Key (+) LOCKING KEY R-NET EUR Page 10 of 14

11 Joystick knobs (+) JOYSTICK KNOB BALL SMALL EUR JOYSTICK HANDLE BODYPOINT 3" U-SHAPED EUR JOYSTICK HANDLE BODYPOINT 4" U-SHAPED EUR JOYSTICK HANDLE BODYPOINT RUBBER DOME EUR JOYSTICK KNOB STANDARD EUR JOYSTICK KNOB BALL BIG EUR JOYSTICK KNOB CHIN CUP EUR JOYSTICK KNOB MUSHROOM EUR JOYSTICK KNOB SOFT BALL EUR JOYSTICK KNOB STICK EUR JOYSTICK KNOB T-GRIP EUR JOYSTICK SOFTBALL BLACK WITH CONE EUR Attendant control Attendant control (+) ATTENDANT CONTROL CJSM2 R -NET INCL BRACKET EUR 1, ATTENDANT CONTROL CO-PILO T 2 FOR CORPUS/C3G EUR 2, ATTENDANT CONTROL LED R-N ET INCL BRACKET EUR ATTENDANT CONTROL R-NET I NCL BRACKET EUR Mounting position attendant control (+) MOUNT POS ATTENDANT CON- TROL LEFT EUR MOUNT POS ATTENDANT CON- TROL RIGHT EUR - Emergency switch (+) EMERGENCY STOP SWITCH EUR Special controls Basic set special control (+) MD TOUCH 400R EUR 2, MD TOUCH 420R EUR 3, Applications (1) (+) MD TOUCH MULTIMEDIA EUR Applications (2) (+) MD TOUCH TEXT TO SPEECH - MESSENGER EUR Applications (3) (+) MD TOUCH TTS SCANNING EUR TTS Voice (+) MD TOUCH VOICE ES EUR Input Device DL EC/MDT (+) SWITCH CONTROL (STD SCA NNER COLUMN/ROW) EUR SWITCH CONTROL (1 SWITC H WITH MANUAL SCAN) EUR SWITCH CONTROL (STD 3 S WITCH "HEAD" CONTROL) EUR SWITCH CONTROL (STD 4 S WITCH) EUR SWITCH CONTROL (STD 4 S W + EXTRA FUNCTION SW) EUR FOOT CONTROL FOR MDT/RNET EUR 1, JOYSTICK COMPACT ADV. R-NET EUR JOYSTICK COMPACT R-NET EUR JOYSTICK COMPACT LIGHT R- NET EUR JOYSTICK MINI R-NET EUR 1, NO INPUT DEVICE / MDT IS OUTPUT ONLY EUR TABLET CONTROL FOR MDT/RN ET EUR 2, VIC CCD FOR MDT/RNET EUR 1, Holder (+) HOLDER CHINSTEERING EUR HARNESS FOR CHIN CONTROL EUR PANEL HOLDER PARALLEL MOTION UNITRACK EUR PERMOFIX HOLDER COMPACT JOYSTICK EUR PERMOFIX HOLDER COMPACT JOYSTICK + DISPLAY EUR PERMOFIX HOLDER MINI JOYSTICK EUR Page 11 of 14

12 Holder (+) PERMOFIX HOLDER MINI JOYSTICK + DISPLAY EUR PERMOFIX HOLDER CENTRE MOUNTED COMPACT JOYSTICK EUR PERMOFIX HOLDER CENTRE MOUNTED MINI JOYSTICK EUR WITHOUT PANELHOLDER EUR - Holder Display (+) PERMOFIX HOLDER DISPLAY EUR Mounting position input device (+) MOUNT POS DL/MD CONTROL LEFT EUR MOUNT POS DL/MD CONTROL RIGHT EUR - On/off switch (+) BUDDY BUTTON BLACK 63 MM EUR BUDDY BUTTON RED 63 MM EUR BUDDY BUTTON YELLOW 63 MM EUR CUP SWITCH 45 MM EUR SWITCH DOUBLE FOR COMP JOYSTICK MD EC R-NET OMNI EUR GRASP SWITCH EUR MICRO LIGHT SWITCH EUR MINI CUP SWITCH 24 MM EUR SWITCH KIT FOR COMPACT JS (CHIN) EUR Function select switch (+) BUDDY BUTTON BLACK 63 MM EUR BUDDY BUTTON RED 63 MM EUR BUDDY BUTTON YELLOW 63 MM EUR CUP SWITCH 45 MM EUR GRASP SWITCH EUR MICRO LIGHT SWITCH EUR MINI CUP SWITCH 24 MM EUR Joystick knobs (+) JOYSTICK KNOB BALL SMALL EUR JOYSTICK HANDLE BODYPOINT 3" U-SHAPED EUR JOYSTICK HANDLE BODYPOINT 4" U-SHAPED EUR JOYSTICK HANDLE BODYPOINT RUBBER DOME EUR JOYSTICK KNOB STANDARD EUR JOYSTICK KNOB BALL BIG EUR JOYSTICK KNOB CHIN CUP EUR JOYSTICK KNOB MUSHROOM EUR JOYSTICK KNOB SOFT BALL EUR JOYSTICK KNOB STICK EUR JOYSTICK KNOB T-GRIP EUR JOYSTICK SOFTBALL BLACK WITH CONE EUR MD Accessories IR-mouse receiver (+) MD IR MOUSE RECEIVER USB EUR IR receiver (+) MD EC IR RECEIVER 8 CHANNEL / BOX EUR Emergency switch (+) EMERGENCY STOP SWITCH EUR Touch contact (+) DL/MD EC TOUCH CONTACT EUR Powered swing away steering (+) POWERED SWING AWAY CHIN / SIPP&PUF UNIT EUR 2, EC external speaker (+) MD EC EXTERNAL SPEAKER EUR EC Microphone (+) MD EC MICROPHONE ON GOOSE NECK EUR Charger MagicDrive Touch (+) MD TOUCH CHARGER EU EUR Page 12 of 14

13 Charger MagicDrive Touch (+) MD TOUCH CHARGER UK EUR Supplementary accessories Compact joystick (+) JOYSTICK COMPACT LIGHT R- NET EUR JOYSTICK COMPACT R-NET EUR Mini Joystick (+) JOYSTICK MINI R-NET EUR 1, Chest support table (+) CHEST SUPPORT FOR TABLE CII/VII VINYL EUR Bluetooth mouse (+) BLUETOOTH MODULE FOR 1st MOUSE CTRL R-NET ASSY KIT EUR Extra Bluetooth mouse (+) BLUETOOTH MODULE FOR 2nd MOUSE CTRL R-NET ASSY KIT EUR Bluetooth idevice (+) BLUETOOTH MODULE FOR idev ICES EUR Cable extra switch BT (+) CABLE ADAPTER MOUSE CONTR OL BLUETOOTH R-NET EUR _Charger USB (+) USB CHARGER CORPUS/CORPUS VS EUR _Mounting position USB Charger (+) MOUNT POS USB CHARGER LEF T EUR MOUNT POS USB CHARGER RIG HT EUR - Swing away switch left for Stealth headsupport (+) STEALTH SWING AWAY EGG SW KIT FOR CMFRT PLUS HEADR EUR Swing away switch right for Stealth headsupport (+) STEALTH SWING AWAY EGG SW KIT HEADR - RIGHT EUR Switch set Chin control (+) SWITCH KIT FOR COMPACT JS (CHIN) EUR Buddy button 63 mm Black (+) BUDDY BUTTON BLACK 63 MM EUR Buddy button 63 mm Red (+) BUDDY BUTTON RED 63 MM EUR Buddy button 63 mm Yellow (+) BUDDY BUTTON YELLOW 63 MM EUR Micro light (+) MICRO LIGHT SWITCH EUR Cup (+) CUP SWITCH 45 MM EUR Mini cup (+) MINI CUP SWITCH 24 MM EUR Grasp (+) GRASP SWITCH EUR Switch (Egg) black (+) STEALTH EGG SWITCH BLACK W FLATHEAD PHILLIPS BOLTS EUR Connection box external switches seating (+) SWITCH BOX ALTERNATIVE ICS 8-INPUT EUR Connection box external switches R-net (+) REMOTE BUTTON INTERFACE R -NET EUR Page 13 of 14

14 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 14 of 14

F3 Corpus. Price list: 27 Spain EUR. Dealer Information. Client Information. Client Measurements

F3 Corpus. 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