Order Date : k-series. titanium. Please make your selection with a cross in the box Standard feature Free of Charge

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1 Manual Wheelchair Retail Prescription Form KSeriesTitanium Tel: Fax: July 2016 Online spares available at: Customer Ref: Account No : Built in Switzerland Contact No: Delivery address : Order Qty : Order Date : the k-series titanium Standard Features Maximum user weight 120kg (19 stone) Active Rigid Wheelchair with Height Adjustable Aluminium Rigid Footrest Multiple adjustments, Front & Rear Seat Heights and Centre of Gravity Titanium Front Frame 75 or 90 Front Angle Standard Seat Upholstery 24" Self Propel Q/R Wheels with Grey Aluminium Handrims & Schwalbe Black & Grey Pneumatic Tyres Choice of 8 Seat Widths 340mm to 480mm Choice of 4 Seat Depths 375mm to 450mm Range of Front Seat Heights from 480mm to 520mm Range of Rear Seat Heights from 380mm to 490mm Aluminium Lockdown Folding, Angle & Height Adjustable Backrest Black & Grey Nylon Tension Adjustable Upholstery Without Push Handles, Carbon Clothesguards Aluminium Axle Tube with 3 Camber Black Comfort Front Castor Standard Brake Lever Bent Tool Kit Standard Base Price 1,895 X Code DDZ0000 Please make your selection with a cross in the box Standard feature Free of Charge Customer weight = Kg Description Küschall K-series Titanium Special Basic Model - PLEASE COMPLETE DETAILS AT THE END OF THE FORM SEATING CHOICE TITANIUM FRAME DDA0287 K Series Titanium 75 Front Frame sand blast finish (No paint finish available) Footplate width = seat width less 150mm (V style front frame) DDA0292 K Series Titanium 90 Front Frame sand blast finish (No paint finish available) Footplate width = seat width less 150mm (V style front frame) SEAT WIDTH (SB) Retail P.O.A. Footplate width = Seat width less 150mm Width between clothes guards = Seat Width + 15mm Matrx backrests and seat cushions are not available with 340mm seat width, option DDA0124 Matrx MX1 backrest is not available with 480mm seat width, option DDA0138 Matrx Libra cushion is compatible with seat sizes mm wide and mm deep Matrx Vi cushion is compatible with seat sizes mm wide and mm deep Seat width 360mm on Matrx Libra & Vi cushions is only available with 400mm & 420mm seat depths 1 of 7

2 SEAT POSITION (SP) Note: Position 1 is the most active position DDA0461 Position 1 = 140mm The seat position can be moved forward and backward along the frame to achieve a more active or stable rear wheel position. DDA0462 Position 2 = 125mm DDA0463 Position 3 = 110mm DDA0464 Position 4 = 95mm DDA0465 Position 5 = 80mm BACK HEIGHT (RH) Option DDA0772 to suit Matrx or fixed backrest with rounded back bar or DDA0773 to suit Matrx or fixed backrest with horizontal back bar are only available in aluminium and are set at a back height of 285mm, option DDA0580 Back height 270mm is not available with Height adj rear set push handles, option DDA0703 In combination with tubular armrests, back height of between 270mm and 330mm are only possible with fixed push handles long or short, or without push handles FRONT SEAT-TO-FLOOR (SHv) REAR SEAT-TO-FLOOR (SHh) Armrests DDA1416 & DDA1421 are not available with rear seat heights 380mm - 410mm 25" rear wheels not available on rear seat height 380mm 26" rear wheels not available on rear seat heights 380mm and 390mm KNEE-TO-HEEL LENGTH (UL) On 75 Titanium frames: Maximum Knee to heel (UL) must be front seat height minus 30mm On 90 Titanium frames: Maximum Knee to heel (UL) must be front seat height minus 40mm Knee to heel must be measured taking away the cushion thickness Knee to heel lengths of less than 390mm in certain configurations could be delivered with an upmounted footplate BACKREST BACKREST MATERIAL DDA0730 Aluminium DDA0731 Titanium (NC: 0703,0772,0773) 150 BACKREST TYPE DDA0770 DDA0772 DDA0773 Standard backrest (NC: 0733) Standard backrest is not compatible with Matrx backrests Backrest to suit Matrx or fixed backrests. Rounded back bar Backpost height 285mm, supplied without upholstery Backrest to suit Matrx or fixed backrests. Horizontal back bar Backpost height 285mm, supplied without upholstery (NC: 0751,0702,0703,0704) (NC: 0751,0702,0703,0704) 2 of 7

3 MATRX BACKREST (Hardware is supplied mounted to the backposts with the backrest supplied in the box with the wheelchair, extra leadtime applies) DDA0753 Matrx MX1 with Dual Mount Q/R hardware Height of backrest 230mm 595 DDA0754 Matrx MX1 with Dual Mount Q/R hardware Height of backrest 310mm MX1 backs are compatible with seat widths 360mm - 460mm 595 DDA0755 Matrx MX1 with Dual Mount Q/R hardware Height of backrest 410mm 595 DDA0756 Matrx Elite Deep with Easy-set mounting hardware Height of backrest 310mm Compatible with seat widths 360mm - 480mm 450 DDA0758 Matrx Elite Standard with Easy-set mounting Height of backrest 260mm Compatible with seat widths 360mm - 480mm 406 DDA0760 Matrx Elite Standard with Easy-set mounting Height of backrest 360mm Compatible with seat widths 360mm - 460mm 406 BACK UPHOLSTERY DDA0722 Black & Grey Nylon upholstery with tension adjustable back DDA0735 Aero upholstery with tension adjustable back PUSH HANDLES DDA0750 Without push handles DDA0751 Fixed push handles short 97 DDA0702 Fixed push handles long 97 DDA0703 Height adjustable, rear set 185 DDA0704 Foldable push handles 144 DDA0733 Height adjustable integrated push handles, for without upholstery 160 BACKREST ANGLE DDA Angle from the seat DDA Angle from the seat DDA Angle from the seat DDA Angle from the seat DDA Angle from the seat SEATING SEAT UPHOLSTERY DDA0610 Standard DDA0615 Light seat upholstery 50 DDA0611 Tension adjustable seat with one central velcro band (loop) 32 SEAT BAG/POUCH DDA0606 Seat Bag/Pouch (Mounted underneath seat, removable) 53 SEAT CUSHION DDA0600 Seat cushion 6cm foam with visco layer 48 DDA0662 Matrx Libra with Black Smooth cover Very High risk Matrx Libra is compatible with seat sizes mm wide pressure & positioning cushion & mm deep 319 DDA0663 Matrx Vi with Black Meshtex cover High risk pressure & positioning cushion Matrx Vi is compatible with seat sizes mm wide & mm deep 335 FOOTREST FOOTREST TYPE DDA1508 Foot tube rigid - Aluminium (NC: 1570) DDA1509 Foot tube rigid - Titanium (Not possible with upmounted footrest) (NC: 1570) 135 DDA1570 Carbon footplate, angle adjustable (NC: 1513) 150 FOOT TUBE COVER DDA1513 Foot tube cover select with foot tube rigid options only 25 CLOTHESGUARDS/MUDGUARDS DDA1401 Carbon clothes guards (NC: 1408) DDA1408 Carbon mud guards (NC: 1416,1421) 205 ARMRESTS DDA1416 Armrest, height adjustable, short, non locking. If armrests are required, also select clotheguards 120 DDA1421 Armrest, height adjustable, long, non locking. If armrests are required, also select clotheguards 120 TUBULAR ARMREST: If tubular arms are required, in combination with back heights of mm only fixed or without push handles are available DDA1411 Tubular armrest. Height adjustable, removable, non-locking, swing-away & comfort padded 175 COLOUR-POWER-SET (CPS) CPS comprises of rear wheel rims, wheel hub and Q/R push buttons, castor forks, castor housing caps, seat module caps and backrest plate DDA0330 Colour-Power-Set techno-anthracite DDA0334 Colour-Power-Set b-blue DDA0329 Colour-Power-Set comet red DDA0336 Colour-Power-Set arctic blue DDA0337 Colour-Power-copper glaze DDA0338 Colour-Power-chrome Starec wheel rim supplied in black when Chrome CPS is selected DDA0339 Colour-Power-champagne DDA0340 Colour-Power-olive 3 of 7

4 FRONT WHEEL (5" Front castors are not available with a 90 front frame) DDA mm (3") Supersport DDA mm (4") Everyday wheel with black tyre DDA mm (4") Starec techno-anthracite DDA mm (4") Starec b-blue DDA mm (4") Starec comet red DDA mm (4") Starec copper glaze DDA mm (4") Starec arctic blue DDA mm (4") Starec black DDA mm (4") Starec chrome DDA mm (4") Starec champagne DDA mm (4") Starec olive DDA mm (4") Skater wheel DDA mm (4") Comfort wheel with black tyre DDA mm (5") Light wheel with black tyre DDA mm (5") Comfort wheel with black tyre DDA mm (5") Starec techno anthracite DDA mm (5") Starec b-blue DDA mm (5") Starec comet red DDA mm (5") Starec copper glaze DDA mm (5") Starec arctic blue DDA mm (5") Starec black DDA mm (5") Starec chrome DDA mm (5") Starec champagne DDA mm (5") Starec olive REAR WHEEL FIXATION DDA0250 x Standard rear wheel position CAMBER AXLE TYPE 10 Camber on Vario-Ax only locks with an Active Brake DDA0276 Vario-Ax, adjustable Camber 1/3/7/10 (NC: 0927,1302) 205 DDA0277 Standard axle DDA0278 Carbon axle (reduces weight by 180g) (NC: 1705) 145 CAMBER ANGLE DDA camber DDA camber DDA camber QUAD RELEASE AXLE DDA0909 Quad quick release axle (NC: 0906,0927) 62 REAR WHEEL SIZE DDA0902 DDA0925 DDA mm (24") wheel (NC: 0918) 635mm (25") wheel (NC: 0906,0908,0913,0915,0927) 660mm (26") wheel (NC: 0906,0908,0918,0913,0927,1303,1705) REAR WHEEL TYPE DDA ", 26" Küschall Starec with cross spokes (hub colourless and rim black or in CPS if selected) (NC: 1399) DDA " High performance wheel (Starec hub, spokes & rim black, hub only in CPS if selected) (NC: 1004,1006,1007,1399) 185 DDA " High Performance wheel (NC: 1014,1002,1004,1006,1007,1102,1104,1106,1200, (Starec hub, spokes & rim black, hub only in CPS if selected) 1202,1399) 266 DDA " Mountain Bike, fitted with specific 24" x 1.75" tyre (NC: 1014,1002,1004,1006,1011,1010,1007,1104,1106,1120, Choice of Aluminium or Supergripp handrim CPS not available 1202,1399) " Spinergy LXK wheel (Black lightweight hub, 18 spokes black, No CPS) DDA0906 Coloured spokes are available via MyKuschall, please indicate requirements (NC: 1004,1006,1007,1200,1202,1399) 445 in the space provided at the end of the form. 24" Spinergy SPOX wheel (Chrome hub, 18 spokes in black, no CPS) SWO0907 Coloured spokes are available via MyKuschall, please indicate requirements (NC: 1004,1006,1007,1200,1202,1399) 340 in the space provided at the end of the form. 24" Spinergy LX wheel (Chrome hub, 12 spokes in black no CPS). SWO0909 Coloured spokes are available via MyKuschall, please indicate requirements (NC: 1004,1006,1007,1200,1202,1399) 529 in the space provided at the end of the form. DDA " Wheel with integrated hub brakes (Silver spokes with black hub and rim) CPS not available (NC: 1004,1006,1007) 500 REAR WHEEL TYRE DDA ", 25", 26" Schwalbe rightrun black & grey tyre DDA " Profile tyre 7 bar DDA " Solid tyre, profil, grey 48 DDA " Solid tyre black (KIK) 63 DDA ", 25" Schwalbe One with V Guard puncture protected 62 DDA ", 25", 26" Marathon plus tyre with Smartguard rubber infill, puncture protected (NC: 1020) 73 DDA " Solid tyre Light, grey 48 4 of 7

5 ANTI-FLAT PROTECTION DDA1020 Anti-flat tyre tube protection 15 HANDRIM DDA ", 26" Supergripp, long tab, 2 hole set at 3 cm distance 145 DDA ", 26" Steel polished, short tab, 1 hole set at 3 cm distance 45 DDA " Titanium, short tab, 1 hole set at 3 cm distance 128 DDA ", 25" Surge LT 30mm dist 237 DDA1113 DDA1114 DDA ", 25", 26" Light Alu black, short tab, 1 hole set at 3 cm distance 30 SPOKE GUARDS DDA ", 26" Transparent 85 DDA " Küschall Black with white logo 85 SAFETY DDA ", 25", 26" Light Alu grey, short tab, 1 hole set at 3 cm distance 24", 25", 26" Light Alu grey, long tab, 2 hole set at 4 cm distance Standard brake lever bent DDA1302 Performance brake (NC: 1310) 55 DDA1303 Active/Scissor brake (NC: 1310) 55 DDA1399 Without brake Can only be selected with DDA0927, wheel with hub brakes DDA1310 Extension lever for standard brake 32 DDA1730 Seat belt 54 ANTI TIPPER DDA1702 Anti-tipper tube right 89 DDA1703 Anti-tipper tube left 89 DDA1704 Anti-tipper tube both sides 178 DDA1705 Active Anti-tipper 150 ACCESSORIES DDA1715 Air Pump 10 DDA1712 Küschall watch, right side, mounted in castor housing (NC: 1713) 77 DDA1713 Küschall watch, left side, mounted in castor housing 77 DDA1717 Tool Kit DDA1739 Front frame protectors 1 pair (Not with upmounted footplate) 24 DDA1746 Mobile phone holder 20 DDA1734 Mountain bike wheels with bag, includes quick release axles 199 PRICE Total Price Non Conforming Items Guide DDA0702 DDA0703 DDA0704 DDA0733 DDA0751 DDA0772 DDA0906 DDA0908 DDA0913 DDA0915 DDA0918 DDA1001 DDA1002 DDA1004 DDA1006 DDA1007 DDA1010 DDA1011 DDA1020 DDA1102 DDA1104 DDA1106 DDA1120 DDA1200 DDA1202 DDA1302 DDA1303 DDA1310 DDA1399 DDA1408 DDA1411 DDA1416 DDA1421 DDA1570 DDA1705 DDA1713 Push handles fixed long Height adjustable rear set push handles Foldable push handles Height adjustable integrated push handles Push handles fixed short Without backrest upholstery 24" Spinergy LX wheels 24" High Performance wheel 24" Mountain Bike wheel 24", 26" küschall Starec 25" High Performance wheel Light wheel 7 bar Profile tyre 7 bar Solid tyre, profil, grey Solid tyre (KIK) black Solid tyre Light, grey Marathon Evolution tyre Schwalbe One tyre Anti-flat tyre tube protection Supergripp handrim,24",26" dist. 3 cm Steel polished handrim, 24",26" dist. 3 cm Titanium handrim, 24 "dist. 3 cm Surge LT Handrim Transparant Spokeguards Küschall Spokeguards Performance brake Active brake Extension lever for standard brake Without brakes Carbon mud guards Tubular armrest, height adjustable, removable, swing-away, comfort padded Siderest, height adjustable, short Siderest height adjustable, long Carbon footplate angle adjustable Active Anti-tipper Kuschall watch left 5 of 7

6 TITANIUM My KÜschall special build instructions Please fill out the required measurements in the table if applicable and give full details of the special request in the space provided below. 6 of 7

7 7 of 7

8 Matrx Seating & Positioning Options - THE COMPLETE SOLUTION The Invacare Seating & Positioning range features a vast array of pressure redistributing cushions from low to very high risk, and a number of backrest styles to suit a variety of postural needs. Below is a selection of the options available on chair, further information on the complete solution can be found on individual prescription forms or alternatively visiting us online at Prescription Guide Effective seating should provide postural support and comfort, as well as help to reduce the risk of pressure ulcer development. There are a number of extrinsic factors that can influence the effectiveness of a seat cushion in relation to pressure care, our cushions have been designed taking these factors into account explained below. Cushion Options -(For additional sizes please refer to the individual cushion prescription form) Matrx Flo-tech Lite Slimline contoured cushion ideally suited to people at low risk of developing pressure ulcers and for comfort purposes only. The contoured seating surface offers improved stability and postural support. Matrx Vi The unique three part foam construction targets skin protection where it is needed most. TheInvacare Matrx Vi Cushion is anatomically designed with dual-density, HR foam layers and includes a Viscoelastic foam insert, pre-ischial contour and trochanteric shelf. Matrx Libra Designed with the highest level of skin protection, positioning and adjustability to match the unique needs of the person, the Invacare Matrx Libra Cushion offers a complete solution to provide balance and stability as well as optimize body function. Low Risk Overall height 3" Max UW 127kg (20 stone) High Risk Overall height 3.25" Max UW 136kg (21 stone) Very High Risk Overall height 3.25" Max UW 136kg (21stone) Backrest Options -(For more information please refer to the Matrx brochure) Matrx MX1 A lightweight carbon fibre back, designed for active people who demand peak performance and great looks. Lightweight carbon fibre back shell - weighs from approximately 900 grams, including hardware Full range of anterior / posterior angle adjustment 3" / 75mm of contour depth provides stable midline support Carbon fibre shell delivers exceptional support, durability and aesthetic appeal Range of three patent pending hardware options available for fitting the back to a wheelchair Hardware options provide optimal adjustment for the widest range of applications, ensuring a great fit for the person. Hardware: Quick release dual mount back cane hardware with quick release tabs. Matrx Elite Designed to provide precise orientation within the wheelchair for optimal postural support. The attractive, lightweight design appeals to people with active lifestyles. Features : 3" Contour Depth 40 angle adjustment 4" depth adjustment 20 rotation 136kg (21 stone) Max UW 510mm Matrx Elite Deep Featuring integrated lateral supports to provide trunk support while allowing clearance for the shoulders and hips. Features : 6" Contour Depth 40 angle adjustment 4" depth adjustment 20 rotation 136kg (21 stone) Max UW 510mm Bodypoint- Positioning Accessories (Currently only available as spare parts- please refer to the UK Bodypoint price list) Belts Aselection of 2 and 4 point padded hip belts are available, that facilitate aligned, stable pelvic position. Multiple pull options and buckle styles accommodate a variety of needs Harnesses Designed to provide shoulder retraction, good head control and to correct shoulder rotation, Bodypoint shoulder harnesses assure comfort, durability and easy care. Foot Supports Used for stabilising and positioning the feet while still allowing for controlled movement. A comfortable and dynamic alternative to rigid shoe holders or foot straps Customer Ref: Order Number: Subject to Invacares standard terms conditions.

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