BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e

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1 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 * Tag Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Shipping Address * * required F r a m e T y p e Bentley 20 Manual Tilt Wheelchair $ 3,695 F r a m e O p t i o n s Standard Base and Seat Frame 250 lbs Weight Capacity Upgraded Base and Seat Frame 300 lbs Weight Capacity with addition of a secondary Gas Strut. Available for Seat Widths up to 22". $ Heavy Duty Base and Seat Frame 450 lbs Weight Capacity. Available for all sizes, but required for Seat Width of 23" or wider. $ 300 Requires 20 Composite or 24 Heavy Duty Spoked Wheels. Fixed Axles only. Not compatible with Transit Tie Down System Extended Base with Rear Floor Jacks $ 600 Lifts Rear Wheels off ground for increased stability. Limited ground clearance. Not compatible with Attendant wheel lock, HD Anti-Tipper, IV Pole, O2 Holder Transit Tie Down System (TTDS) TTDS includes 4 factory-installed transport brackets. TTDS has been tested according to ANSI/RENSA WC 19. See Owners Manual for complete details. Not compatible with Attendant Wheel Locks, Extended Base, and Widths greater than 22". Tested to max. Weight Capacity of 300 lbs. S e a t W i d t h Overall chair width is +9.5" for 12/16" RW and +10.5" for 20/22/24" RW Standard Seat Widths " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width $ 215 Custom Seat Widths Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply " Seat Width " Seat Width " Seat Width $ " Seat Width $ " Seat Width " Seat Width " Seat Width $ " Seat Width " Seat Width " Seat Width $ 625 S e a t D e p t h Standard Seat Depths (Adjustable) " Seat Depth " Seat Depth " Seat Depth " Seat Depth " Seat Depth Custom Seat Depths " Seat Depth " Seat Depth $ 325 F r a m e C o l o u r PDG Premium Colours Tracer Red Gloss Black Silver Black Shimmer Orange Fusion Karl s Imagination Blue Shimmer Gloss White Dark Titanium Geyser Green Lollypop Blue Lollypop Red Bubble Gum Pink Berry Purple Safety Yellow Custom Colour Contact PDG for specifications. $ 300 PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

2 A r m T y p e No Armrest Single Post Fixed Height (12") Full Length Armpad only. Single Post Adjustable Height Not compatible with the Heavy Duty Base and/or Seat Width greater than 22". $ "-11" "-14" Dual Post Fixed Height (12") Full Length Armpad only. Dual Post Adjustable Height $ "-11" "-14" "-16" Locking Flip-up Not recommended for users with excessive strength or tone. Not compatible with Fold Down Back, Clothing Guards, Back Upholstery. $ Set at 10" Set at 11" Set at 12" Set at 13" Set at 14" A r m r e s t s Regular Armpads Desk Length - 2" x 10" Full Length - 2" x 14" Full Length Premium Grade - 2" x 14" $ 35 Wide Armpads May interfere with wheels in some tilt configurations. $ Desk Length - 3" x 10" Full Length - 3" x 12" Gel Armpads May interfere with wheels in some tilt configurations. $ Full Length - 2" x 12" Full Length - 3.5" x 12" Contour Arm Trough with Hand Pad May interfere with wheels in some tilt configurations. $ Right (4.5" x 18") Left (4.5" x 18") Armrest Wideners for Dual Post Armrests Limits tilt. Not compatible with 20, 22" or 24 Rear Wheels, Clothing Guards. $ 375 Clothing Guards Not compatible with Flip-up Armrests, Armrest Wideners For Single Post Armrests Available for 10"-14" Height range only. $ For Dual Post Armrests $ 165 Armrest Extensions Not compatible with Flip-up or Single Post Armrests. $ " Extension - Forward " Extension - Rearward S e a t P a n No Seat Pan Solid Seat Pan $ 120 C u s h i o n No Cushion nxt BioFit "-20" width, 16"-20" depth $ "-24" width, 16"-20" depth $ 625 Cushion Size Available in even number sizes only Specify Size (Width" x Depth") PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

3 S e a t H e i g h t Select desired Seat-to-Floor Height STF Height is adjustable within the Range (Low/High/Extra-High) and Rear Wheel size. 6" Casters 8" Casters RW Low High Extra-High 12" 13" 14" 15" 15" 16" 17" 15" 16" 17" 18" 16" 15" 16" 17" 17" 18" 19" 17" 18" 19" 20" 20" 13" 14" 15" 15" 16" 17" 15" 16" 17" 18" 22" 14" 15" 16" 16" 17" 18" 16" 17" 18" 19" 24" 15" 16" 17" 17" 18" 19" 17" 18" 19" 20" RW Low High Extra-High 16" 15" 16" 17" 17" 18" 19" 17" 18" 19" 20" 24" 15" 16" 17" 17" 18" 19" 17" 18" 19" 20" Wheel size Caster size STF height Range C a s t e r s Urethane 8" Casters are compatible only with 16 and 24 Rear Wheels " x 1.25" Caster size " x 1.50" Caster size $ " x 1.25" Caster size " x 2.00" Caster size $ 135 Pneumatic 8" Casters are compatible only with 16 and 24 Rear Wheels " x 1.25" Caster size $ " x 1.25" Caster size $ " x 2.00" Caster size $ " Soft Roll $ Ultra Sport Fork Not compatible with 12, 20, or 22 Rear Wheels. Requires 6 Soft Roll Caster. $ 395 R e a r W h e e l s Composite " Wheel size " Wheel size " Wheel size " Wheel size " Wheel size Spoke $ " Wheel size " Wheel size " Wheel size " Heavy Duty Spoke Required for Heavy Duty Base and Seat Frame. $ 350 A x l e T y p e Quick Release Rear Axles Fixed Rear Axles R e a r T i r e s Urethane Pneumatic Pneumatic Tires may result in a finished Seat Height 1/2" greater than stated. $ Pneumatic with Flat-Free Inserts $ 95 H a n d R i m s Pneumatic Tires may result in a finished Seat Height 1/2 greater than stated. Not compatible with Spoke Wheels No Hand Rims Standard 20", 22", and 24" Rear Wheels only Plastic Coated 20", 22", and 24" Rear Wheels only. $ 95 PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

4 W h e e l L o c k s Push to Lock Pull to Lock Attendant Wheel Lock (Push to Lock) $ 85 Not compatible with TTDS or Width greater than 23" on chairs with Upgraded or Heavy Duty Base and Seat Frame User & Attendant Wheel Lock Available only on 20", 22", or 24" Rear Wheels. $ Wheel Lock Extensions Not compatible with Attendant Wheel Lock. $ Hill Holders Requires Pneumatic Rear Tires with Flat-Free Inserts. $ 350 A n t i - T i p p e r s Rear Anti-Tippers Required Safety Option. $ Front Anti-Tippers $ Heavy Duty Rear Anti-Tipper $ 600 Provides additional rearward stability for users with excessive movement. Not compatible with Attendant Wheel Locks, Rear Floor Jacks, IV Pole, O2 Holder. B a c k P o s t S t y l e Push Bar Back Cane Handle Back Seat Widths of 14"-22" only. Not compatible with Headrest Mounting Plate. Back Post Height Seat Pan to Handle " Height " Height B a c k O p t i o n s Angle/Height Adjustable Push Bar Handle Not compatible with Headrest Mounting Plate or Cane Handle Back. $ Button on Outside Button on Inside Seat to Back Angle Set at Set at Set at Set at Set at " Backrest Extension Not compatible with Angle/Height Adjustable Push Bar Handle. $ Fold Down Back Not compatible with Reclining Back Spring Back Suspension Not compatible with Reclining Back Dynamic Rocker Back Assembly $ 2,995 Not compatible with Fold Down Back, Spring Back Suspension, 30 Recline, Cane Handle. Upholstery must be Adjustable Tension. Finished Back Post Height 3 taller than selected Back Post Height. Requires longer Frame. B a c k U p h o l s t e r y No Back Upholstery Standard Back height measured from Seat Pan to top of Upholstery. $ Set at 21" Set at 22" Short 25" Back only. Back height measured from Seat Pan to top of Upholstery. $ Set at 18" Set at 19" Set at 20" Tall 31" Back only. Back height measured from Seat Pan to top of Upholstery. $ Set at 24" Set at 25" Set at 26" Adjustable Tension Back height measured from Seat Pan to top of Upholstery. $ Set at 21" Set at 22" Set at 23" B a c k r e s t No Backrest See next page for more Backrest options > PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

5 nxt Optima HA Active Contour "-20" width, 16"-20" height $ "-24" width, 16"-20" height $ 720 nxt Optima HA Plus Contour "-20" width, 16"-20" height $ "-24" width, 16"-20" height $ 720 Backrest Size Available in even number sizes only Specify Size (Width" x Height") T i l t / R e c l i n e O p t i o n s Attendant Tilt only Trigger on Right Back Post Trigger on Left Back Post User Tilt only Not available on widths greater than 22". Full Length Arm Pads only. $ Trigger on Right Armrest Trigger on Left Armrest Attendant & User Tilt Not available on widths greater than 22". Full Length Arm Pads only. $ Trigger on Right Back Post Trigger on Left Back Post Trigger on Right Armrest Trigger on Left Armrest Trigger Extension $ Reclining Backrest (Manual) $ 875 H e a d r e s t 30 maximum recline. Not compatible with Backrest Extension, Cane Handle Back, Spring Back Suspension, Fold Down Back, Tension Adjustable Upholstery. Requires longer Frame No Headrest Headrest Mounting Plate $ nxt MultiFit Head Support Hardware $ 155 nxt MultiFit Head Support Pad $ Regular (9" x 5") Large (10" x 5") X-Large (14" x 5") No Front Rigging Sector Blocks only Plug In 70 Not compatible with Backrest Extension, Angle/Height Adjustable Push Bar, Cane Handle Back. Not required if mounting to a solid Back. F r o n t R i g g i n g Plug In Adjustable Knee Angle $ Swing Away Swing Away Swing Away Elevating Legrest $ " Offset Hangers for Swing Away $ 75 F o o t P l a t e s Composite Aluminum Angle Adjustable $ One Piece Fixed Available on Plug In Front Rigging only. Requires selection of Composite or Aluminum Angle Adjustable. $ One Piece Flip-up Requires selection of Composite or Aluminum Angle Adjustable. $ Interlocking Angle Adjustable Seat Widths of 14"-21" only. $ 195 PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

6 F o o t r e s t / L e g r e s t A c c e s s o r i e s Swing Away 60 & 70 Calf Pad Not compatible with 60 & 70 Gel Padding. $ Swing Away 60 & 70 Gel Padding Not compatible with 60 & 70 Swing Away Calf Pad. $ Swing Away ELR Gel Knee Pad $ Adjustable Length Heel Loops $ Bodypoint - Padded Calf Strap Sizes greater than 22" are not padded. $ 105 Miller's Dynamic Footrest Mounts For Plug In Front Rigging $ For Swing Away 70 Front Rigging Not available on 13" STF Height. $ 380 E x t e n s i o n T u b e s Regular Extension Tubes Standard (13"-17") Long (15"-19") $ 75 Extra Strength Extension Tubes (Solid) Available on Plug In Front Rigging only. $ Standard (13"-17") Long (15"-19") P o s i t i o n i n g S t r a p s Bodypoint - Hip Belts Center-Pull Auto Style $ Center-Pull Auto Style, Padded $ Point, Padded $ Bodypoint - Chest Strap $ 85 M i s c e l l a n e o u s O p t i o n s One-Arm Drive Maximum Seat Width of 22". 24" Composite Wheels required. 18" STF minimum. Limits tilt. $ 3, Installed on Right side Installed on Left side Protective Lower Padding $ Gel Hip Guides $ IV Pole Not compatible with HD Anti Tipper, Rear Floor Jacks, Attendant Wheel Locks. $ O2 Holder Not compatible with HD Anti Tipper, Rear Floor Jacks, Attendant Wheel Locks. $ Adhesive Back Hook Strip, 2" x 30" For Cushion mounting. $ 10 O r d e r N o t e s Please send your completed order form by to or by fax to Scan this code or go to pdgmobility.com/products/bentley to learn more about the Bentley 20 Manual Tilt Wheelchair PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone / 6

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