discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed
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1 BITTE DETACH HIER HERE ABTRENNEN AND SEND UND BY ZU FAX OTTO TO OTTO BOCK BOCK FAXEN Base price: EUR x,xxx All prices in EUR, valid from 01/01/2012 to 31/12/2012 Order no.: discovery tmax Article number: 470G22=00000_K q Provide estimate only q Order q Attachment for custom fabrication enclosed Billing address/customer number Technische Änderungen und Druckfehler vorbehalten Technical modifications and printing errors reserved. Delivery address Sales person Name... Date Signature Standard equipment -5 tilt +50 tilt in space cable free foot release rear wheels 12", 16", 22" or 24" solid caster wheels 6", 7" or 8 single push canes push to lock, wheel lock" Ottobock 647F400=EN adjustable push bar transport brackets side plates discovery tmax 1/6
2 tmax Kids [ ] tmax Kids Seat width (between armrests) cm / 12" 16" (seat width at outside seat rails -2,5 cm/1") Seat depth from back canes to front of the seat rails cm / 12" 16" (without back canes +2,5 cm/1") Basic Price Please choose the pre setup: tmax Kids 300 mm (12") Seat depth 325 mm (13") 350 mm (14") 375 mm (15") 400 mm (16") Seat width (between armrests) / seat width at outside seat rails -2,5 cm/1" 300 mm (12") 325 mm (13") 350 mm (14") 375 mm (15") 400 mm (16") tmax Adult [ ] tmax Adult Seat width (between armrests) (seat width at outside seat rails -2,5 cm/1") [ ] cm / 14" 18" [ ] cm / 16" 20" [ ] cm / 18" 22" Seat depth from back canes to front of the seat rails (without back canes +2,5 cm/1") [ ] cm / 12" 16" [ ] cm / 15" 19" [ ] cm / 18" 22" Please choose the pre setup: Seat depth Seat type tmax Adult Seat Pan sizes 300 mm (12") 325 mm (13") 350 mm (14") 350 mm (14") Seat width (between armrests) / seat width at outside seat rails -2,5 cm/1" 375 mm (15") 400 mm (16") 425 mm (17") 450 mm (18") 475 mm (19") 500 mm (20") 525 mm (21") 375 mm (15") 400 mm (16") 425 mm (17") 450 mm (18") 475 mm (19") 500 mm (20") 525 mm (21") 550 mm (22") SA 10 [ ] Without Seat Pan 550 mm (22") SA 11 [ ] Seat Pan with adjustable drop hooks and countersink holes add. charge Seat depth Seat width (between armrests) 300 mm 400 mm (12" 16") 350 mm 450 mm (14" 18") 400 mm 500 mm (16" 20") 450 mm 550 mm (18" 22") 300 mm 400 mm (12" 16") 471C22=SS C22=SS mm 475 mm (15" 19") 471C22=SS C22=SS C22=SS C22=SS mm 550 mm (18" 22") 471C22=SS C22=SS039 discovery tmax 2/6
3 Back type SD 01 [ ] Single push handles short Height (from seat to bend handle) 530 mm / 21,2" SD 02 [ ] Single push handles long Height (from seat to bend handle) 630 mm / 24,2" SD 03 [ ] Angle adjustable push bar, short, Height (from seat to bend handle) 530 mm / 21,2" SD 04 [ ] Angle adjustable push bar long, Height (from seat to bend handle) 630 mm / 24,2" SD 05 [ ] Single push handles, height adjustable cm / 21,2" 24,2" SD 06 [ ] Push bar, height and angle andjustable cm / 21,2" 24,2" Seat to back angle (please choose pre setup) [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 Front rigging SB 01 [ ] Without front rigging SB 02 [ ] 75, swing in/out Footrests SB 10 [ ] Single footplates (composite) SB 11 [ ] Single footplates (aluminum) SB 14 [ ] Single footplates for lower leg length (only tmax kids) Footrest options SB 20 [ ] Leg strap SB 21 [ ] Heel loop pair Frame options SA 01 [ ] Rear anti-tip right SA 02 [ ] Rear anti-tip left SA 03 [ ] Tip assist right SA 04 [ ] Tip assist left Armrest SE 01 [ ] Without armrest SE 02 [ ] Armrest fixed height SE 03 [ ] Armrest height adjustable Armpad SE 20 [ ] Armpad short (pair) SE 21 [ ] Armpad long (pair) SE 22 [ ] Without armpad Side guard SE 10 [ ] Without side guard SE 11 [ ] Side guard for armrest (pair) Transit Option SK 01 [ ] Without transit option SK 02 [ ] 4 transport brackets and wheelchair anchor for pelvic belt (tested according ISO , max. load 100kg/220lbs) discovery tmax 3/6
4 Frame colours 010 [ ] Dormant marine blue 011 [ ] Sparkle granny smith/metallic green 013 [ ] Deep black 014 [ ] Candy red 016 [ ] Silver metallic 019 [ ] White pearl (only for tmax adult) 021 [ ] Purple (only for tmax kids) 022 [ ] Pink (only for tmax kids) Front casters SF 01 [ ] 6" pneumatic SF 02 [ ] 6" solid PU SF 03 [ ] 7" pneumatic SF 04 [ ] 7" solid PU SF 05 [ ] 8" pneumatic SF 06 [ ] 8" solid PU Rear wheel options SG 01 [ ] 12 1/2" composite wheel SG 02 [ ] 16" composite wheel SG 03 [ ] 22" quick release SG 04 [ ] 24" quick release Rear Tire options SG 10 [ ] Pneumatic SG 11 [ ] Solid PU Wheel lock options SH 01 [ ] Push to lock wheel locks (pair) SH 05 [ ] Wheel lock extension SH 07 [ ] Attendant Hublock cane mount (not for 16") discovery tmax 4/6
5 Seat height, please choose pre setup: Seat height tmax Kids 12 1/2" 16" Rear wheel size 22" 24" Seat height, please choose pre setup: Seat height tmax adult 12 1/2" 16" Rear wheel size 22" 24" Front caster size 6" 7" 8" [ ] 325 mm (13") [ ] 325 mm (13") [ ] 325 (13") [ ] 475 mm (19") [ ] 500 mm (20") Front caster size [ ] 390 mm (15,5") [ ] 420 mm (16,5") [ ] 445 mm (17,5") [ ] 470 mm (18,5") [ ] 495 mm (19,5") [ ] 475 mm (19") [ ] 500 mm (20") [ ] 475 mm (19") [ ] 500 mm (20") 6" 7" 8" [ ] 420 (16,5") [ ] 445 (17,5") [ ] 470 (18,5") [ ] 495 (19,5") discovery tmax 5/6
6 Technical data Technical data Size 1 (tmax Kids) Size 2 (tmax Adult) Size 3 (tmax Adult) Size 4 (tmax Adult) Frame width (FW) with 12" wheels SW +6" (15 cm) SW +6" (15 cm) SW +6" (15 cm) SW +6" (15 cm) Seat width between armrest (SW) 12-16" (30-40 cm) 14-18" (35-45 cm) 16-20" (40-50 cm) 18-22" (45-55 cm) Seat width at outside seat rails 11-15" (~28-38 cm) 13-17" (~33-43 cm) 15-19" (~38-48 cm) 17-21" (~43-53 cm) Seat depth (SD) 12-16" (30-40 cm) 12-19" (37,5-47,5 cm) 15-22" (37,5-55 cm) 15-22" (37,5-55 cm) Rear wheels 12"/16"/22"/24" 12"/16"/22"/24" 12"/16"/22"/24" 12"/16"/22"/24" Seat height (SH) 13-18" (35-45 cm) 14-20" (ca cm) 14-20" (ca cm) 14-20" (ca cm) Tilt in space Height back canes from seat plate Back rest inclination Frame length with 12 1/2" wheels (without footrest and anti tipper) from ca. 21" from ~53 cm from ca. 24" from ~61 cm from ca. 24" from ~61 cm from ca. 27" from ~68,5 cm Max. load incl. seat unit 90 kg/200 lbs 136 kg/300 lbs 136 kg/300 lbs 136 kg/300 lbs Frame weight (without seat, footrest, armrest, rear wheels) 15 kg/33 lbs 16 kg/35 lbs 16,5 kg/36 lbs 17 kg/37,5 lbs Front casters 6"/7"/8" 6"/7"/8" 6"/7"/8" 6"/7"/8" discovery tmax 6/6
discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed
BITTE DETACH HIER HERE ABTRENNEN AND SEND UND BY ZU FAX OTTO TO OTTO BOCK BOCK FAXEN Base price: EUR x,xxx All prices in EUR, valid from 01/01/2012 to 31/12/2012 Order no.: discovery tmax Article number:
Order no.: ... Date Signature. Posterior seat height
Start M6 Junior Scripted Order no.: Start M6 Junior Lightweight wheelchair Article number: 480F53=60000_K Provide estimate only Order Billing address/customer number Ottobock START_M6_647F263=EN-05-1510
Start M2S. Lightweight wheelchair. Unit price: EUR X,XXX (side panels and footrests included) Provide estimate only Order. Standard equipment
Unit price: EUR X,XXX (side panels and footrests included) All prices in EUR, valid from 01/01/2017 to 31/12/2017 Start M2S Lightweight wheelchair Provide estimate only Order Billing address/customer number
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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BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.
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
STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.
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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Height adjustable footplates, equipped with nylon heel loops. Standard with maintenance free PU front (7 ) and rear wheels (24 ).
Excel G-lite + Compact foldable aluminium wheelchair Perfect for taking with you wherever you go due to its light transport weight and compact size. Comfortable back upholstery. Height adjustable comfortable
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Quickie IRIS January 2014
Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: ST: ZIP: Address: Dealer Phone: ( ) Fax: ( )
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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
Standard Base Price: 539
Manual Wheelchair Retail Prescription Form ACTION3JUNIORSMALL19102018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer
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Manual Wheelchair Retail Prescription Form ACTION3JUNIORBASIC05122018 Tel: 01656 776222 Fax: 01656 776220 JANUARY 2019 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer
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Leckey Squiggles Seat
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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:
2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) Freedom 2 Kids
Freedom 2Kids Manual Wheelchair Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Frame Options FD2K Folding Transport Optional (E1236) or (K0005) FD2K-30270 $2085 Note: Transportation
FUZE T50. Order Form USA. Please send your completed order form by to or by fax to
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Quickie QX December 2018
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q Little Wave Flip XP-Rigid Base E1233, E1161 $
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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:
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q Little Wave Flip XP - Rigid Base KF-XPRIGID $
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4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity)
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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MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan.
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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.
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RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"
Manual Wheelchair Retail Prescription Form ACTION515112017 Tel: 01656 776222 Fax: 01656 776220 JAN 2018 Email: ordersuk@invacare.com Online Spares available at www.invacare.co.uk Customer Ref: Contact
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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 S646 SE BD/SD/MPD No Power, Single Power & Multi Power Seating Option AADL - W579
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