Company Name Account # Phone # P.O.# Date FRAME SELECTIONS DEPTH

Size: px
Start display at page:

Download "Company Name Account # Phone # P.O.# Date FRAME SELECTIONS DEPTH"

Transcription

1 WIDTH Price List and Order Form Effective July 1, 200 Revised September 11, 2006 For ease of ordering, contact Customer Service Toll Free at: Fax: To order Literature: Company Name Account # Phone # P.O.# Date Ship To Name & Address Ordering Information When ordering a 900 Series wheelchair, first select the appropriate weight and activity chart from pages 4 thru 8. On that chart, find the width and depth for the user.this will allow you to determine the additional reinforcements required for that chair.then, select any additional miscellaneous accessories from the price list. SERIES S900 Standard 900 Series...1, DEPTH D1 D14 D15 D16 D17 D18 D18K* D19 D20 D20K* D21 D22 W14 $445 $445 $445 N/C $109 $249 $109 $58 $711 $109 $810 $1046 W15 $445 $445 $445 N/C $109 $249 $109 $58 $711 $109 $810 $1046 W16 $445 $445 $445 N/C $109 $249 $109 $58 $711 $109 $810 $1046 W17 $554 $554 $554 $109 $218 $58 $218 $467 $820 $218 $919 $1155 W18 $445 $445 $445 N/C $109 $249 $109 $58 $711 $109 $810 $1046 W19 $694 $694 $694 $249 $58 $498 $58 $607 $960 $58 $1059 $1295 W20 $774 $774 $774 $29 $48 $578 $48 $687 $1040 $48 $119 $175 W21 $774 $774 $774 $29 $48 $578 $48 $687 $1040 $48 $119 $175 W22 $774 $774 $774 $29 $48 $578 $48 $687 $1040 $48 $119 $175 W2 N/A N/A $914 $469 $578 $718 $578 $827 $1180 $578 $1279 $1515 W24 N/A N/A $914 $469 $578 $718 $578 $827 $1180 $578 $1279 $1515 Note: Numbers Represent Inches (Width and Depth). Example: W14 = 14" Wide USER WEIGHT 250N 250 Lbs. and Under...Standard 250A 250 Lbs. and Under Very Active...See Chart Lbs.To 275 Lbs....See Chart Lbs.To 00 Lbs....See Chart Lbs.To 50 Lbs....See Chart SEAT-TO-FLOOR HEIGHT HEMIREC Seat-To-Floor 18'' (Recliner Only) HEMI Seat-To-Floor 18''...No Charge LS-2 Seat-To-Floor 18'' LS-1 Seat-To-Floor 19'' ADULT Seat-To-Floor 20''...No Charge H-1 Seat-To-Floor 21'' TALL Seat-To-Floor 22'' H-2 Seat-To-Floor 22'' H- Seat-To-Floor 2'' H-4 Seat-To-Floor 24'' FOOTNOTES 1. Only available on 14'', 16'' & 18'' widths x 16'' deep (D16 or D18K). All other sizes use LS Only available on 16'' & 18'' widths x 18'' deep (D18 or 20K). All other sizes use H '' back height and 10 headrest extension. Can only use conventional arm styles. Rear anti-tippers are standard.weight limit 50 lbs. 4. Sectional rear uprights only available 12'' - 20'' back heights. 5. Permanent rear uprights only available 12'' - 24'' back heights. 6. BH12 and BH1 are available through specials. Note: All specifications and dimensions are approximate. FRAME SELECTIONS For the most current pricing information refer to 6 * = Depth increase achieved with 2'' seat extension kit ARM & BACK OPTIONS ARM TYPE (All arms are removable.) 18 Full Length, Fixed Height Conventional...No Charge 28 Desk Length, Fixed Height Conventional...No Charge 19 Full Length,Adjustable Height Conventional Desk Length,Adjustable Height Conventional Full Length, Fixed Height Space-Saver...No Charge 79 Full Length,Adjustable Height Space-Saver Desk Length, Fixed Height Space-Saver...No Charge 89 Desk Length,Adjustable Height Space-Saver L8407 Omit Conventional Arms Style...Less BACK TYPE RECLINER2 Recliner Full RECLINER Recliner Semi SECT Sectional Rear Upright (14" - 20")...No Charge 5 PERM Permanent Rear Upright (14" - 24") L8200 Omit Rear Canes...Less BACK HEIGHT BH14 Back Height 14''...No Charge BH15 Back Height 15''...No Charge BH16 Back Height 16''...Standard BH17 Back Height 17''...No Charge BH18 Back Height 18''...No Charge BH19 Back Height 19''...No Charge BH20 Back Height 20''...No Charge BH21 Back Height 21'' w/pivot Spreader...No Charge BH22 Back Height 22'' w/pivot Spreader...No Charge BH2 Back Height 2'' w/pivot Spreader...No Charge BH24 Back Height 24'' w/pivot Spreader...No Charge page 1

2 1 CASTER & REAR WHEEL CASTER OPTIONS '' X 1 /4'' Semi-Pneu. Casters - Lt. Grey BK 8'' X 2'' Pneumatic Casters '' X 1'' Solid Rubber Casters...Standard '' X 1 1 /4'' Pneumatic Casters '' X 1 1 /4'' Pneumatic w/flat Free Inserts L8840 Omit Casters...Less L8790 Omit Caster and Fork Assemblies...Less WHEEL OPTIONS 2244BK 24'' Composite Pneumatic Tires...Standard 4244BK 24'' Composite Pneumatic w/flat Free Inserts U2244BK 24'' Composite Urethane Tires WHEEL OPTIONS (ONE ARM DRIVE) 9457 One Arm Drive w/2244bk Mag Wheel RH One Arm Drive w/2244bk Mag Wheel LH One Arm Drive w/2244bk FF Inserts Right One Arm Drive w/2244bk FF Inserts Left L8701 Omit Rear Wheels...Less HANDRIM OPTIONS AHDRM Aluminum Handrims...Standard 1512 Plastic Coated Aluminum Handrims Alum. Oblique Proj. Handrims, Plastic Coat Alum.Vert. Proj. Handrims, Plastic Coat Alum.Vert Proj. Handrims, Plastic Coat L8702 Omit Handrims...Less UPHOLSTERY COLOR & MODIFICATIONS UPHOLSTERY COLORS U67 Black Vinyl...No Charge U75 Dove Grey Vinyl...No Charge U85 Dark Blue Vinyl...No Charge U86 Ruby Red Vinyl...No Charge U88 Camel Vinyl...No Charge U97 Light Blue Vinyl...No Charge U98 Earthtone Vinyl...No Charge FRAME MODIFICATIONS DX Dual Cross Brace GCJ Gusseted Caster Journal GF-4 Gusseted Frame In Four Places GDX Gussets For Dual Cross Brace CMX Chromoly Crossbrace GCMX Gussets For Chromoly Cross Brace GX Gusseted Cross Brace DAP Dual Axle Position AX 5/8'' Rear-Mounted Axle GA Gussets For 5 /8'' Rear Axle RHB Reinforced Hanger Brackets NHB No Hanger Brackets DXBG Double Cross Brace With Gussets SEAT UPHOLSTERY MODIFICATION US-1 Shorten Seat Upholstery By 1'' RS Dual Seat Liner GAP Vinyl Flap To Fill Seat Gap/Hook & Loop ARM MODIFICATIONS DLA Double Length Arms (For Recliners Only) TLA Triple Length Arms (For Recliners Only) LAJP Lower Adj. Height Arm By Construction - 1'' PMS Permanent Mounted Arms w/screws P58 Permanent Offset Full Length Arms DA-2 Deeper Length Arms 2'' GS Gusseted Arm Sockets AR-1 Raised Arm & Clothing Guard Height 1'' AR-2 Raised Arm & Clothing Guard Height 2'' AR- Raised Arm & Clothing Guard Height '' AR-4 Raised Arm & Clothing Guard Height 4'' AL-1 Lowered Arm 1'' By Construction, Fixed AL-2 Lowered Arm 2'' By Construction, Fixed RCG Reinforced Clothing Guard For Fixed Height FHCG Full Height Clothing Guard NAS No Arm Sockets NAP No Arm Pads - No Holes Drilled In Arm L8405 Omit Arm Pads...Less BACK MODIFICATIONS 5 MRBS Lower Reclining Back By Construction PS Pivot Spreader Bar On Standard Back LBUP Lower Back Upholstery - 1'' RB Dual Back Liner Leatherette Capped Back Welded-On Push Handles RHE Recliner Style 10'' Headrest SB Wider Back Upholstery Slack Back CJB CJ Back Uprights RBG Gusset At Bracket, (Recliner Back) CJHE Headrest Extension For CJ Back (Only) SRUP Straight Rear Uprights...No Charge 9720 No Push Handles NCRU No Camber On Rear Uprights FOOTNOTES 1. Pricing reflects builder sizes only. For standard pricing call Customer Service. 2. 2'' or '' lower. Not available with 18'' seat-to-floor.. Includes clothing protector. 4. Fixed height arms only. 5. Allow back height to be shortened to a minimum of 18''. An 18'' back will only recline to approximate Only available with permanent rear uprights. 7. Reduces seat depth 1'', 2'' or ''. Please specify. Note: All specifications and dimensions are approximate. page 2

3 FRONT RIGGING SELECTIONS FRONT RIGGINGS 1 9 Swingaway Footrests M Minimum Swingaway Footrests 7'' - 11'' E Extended Swingaway Footrests ST Swingaway Tapered Footrests 15 1 /2'' - 20'' M2 Footrests w/ M Style Bracket 11 1 /4'' /4'' H9 Hemi Swingaway Footrests H9M Hemi Minimum Swingaway Footrests H9M2 Hemi Footrests w/ M Style Bracket H9E Hemi Ext. Swingaway Footrests BK Swingaway Elevating Legrests BK Extended Swingaway Elevating Legrests AS4A Smartleg Art. Legrests For14'' - 15'' Wide AHS4A Hemi Smartleg Art. Legrests14'' - 15'' Wide AL4A Smartleg Art. Legrests For 16'' & Above H94 Hemi Swingaway Elevating Legrests H96 Hemi Extended Elevating Legrests AHL4A Hemi Smartleg Art. Legrests 16''& Above FOOTPLATE TYPE 150 Extra Large Aluminum Footplates One Piece Wooden Footboard FOOTREST/LEGREST ACCESSORIES 1820 Non-Removable Device Calf Strap BK Heel Loops With Ankle Straps Toe Loops Legrest Panel H Strap Legrest Board MFXL Minimum Legrest Extension LPT Longer Pivot Tubes Heel Loops FPP Footplate Parallel With Floor L8515 Omit Calf Pads...Less POSITIONING STRAPS SEAT POSITIONING STRAPS 111BK Airline Buckle Seat Positioning Strap Push Button Style Seat Positioning Strap BK Hook & Loop Seat Positioning Strap BACK ACCESSORIES 1160 Carrying Pocket Headrest Extension 12'' High Zipper Back Solid Back Insert Solid Back Insert (Recliner) Torso Support Torso Support For Recliner Head Support For Recliner Head Support '' Lumbar Support '' Lumbar Support L8901 Omit Recline Mechanism...Less L8605 Omit Headrest Extension...Less L8620 Omit Headrest Pillow...Less L8601 Omit Back Upholstery...Less MISCELLANEOUS ACCESSORIES 100 Utility Tray Crutch & Cane Carrier Front Anti-Tippers M Rear Anti-Tippers N Rear Anti-Tippers BK Toggle Wheel Lock Extension (6'') BK Toggle Wheel Lock Extension (8'') Amputee Attachment Hill Holder Tire Pump Shock-Absorbing Forks Caster Swivel Locks IV/Oxygen Holder Package Oxygen Holder Package CHEST POSITIONING STRAPS 711BK Airline Buckle Chest Positioning Strap Push Button Style Chest Positioning Strap BK Hook & Loop Chest Positioning Strap SEAT, BACK & MISC. ACCESSORIES SEAT ACCESSORIES 9661P Wood Drop-Hook Solid Folding Seat SHS 1 /2'' Solid Drop-Hook Seat CSS 1 /2'' Wood Solid Clip-On Seat Solid Seat Insert SHSH Clip-On Solid Seat /4'' Wood Base L8651 Omit Seat Upholstery...Less FOOTNOTES 1. Footrests are standard with heel loops. 2. 2'' wide with hook-and-loop.. Must order omit calf pads. 4. 1'' - 6'' longer, please specify. 5. Only available with 9M s. Note: All specifications and dimensions are approximate. page

4 <250 lbs. Normal Activity Depth 16'' & 17'' 18'' & 19'' OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' RS Dual Seat Liner S S S S S S S S S S S S S CMS Chromoly Cross Brace S S S S S S S S S DS Dual Cross Brace S S S S GDS Gussets for Dual Cross Brace RB Dual Back Liner S S S S S S S S S S S S S PERM Permanent Rear Uprights S S S S S S S S S S S PS Pivot Spreader Bar S S S S GA Gussets for 5 /8'' Axle S S 58AS 5 /8'' Axle S S S S S S S S S S GCJ Gusseted Caster Journal S S S S S S S S S S S S S GF-4 Gusseted Frame 4 Places 920 Suspension Fork 4244BK 24 x 1 /8'' Composite S S S S S S S S S S '' Semi-Pneumatic S S S S S S S S S S S OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' CMS Chromoly Cross Brace S S DS Dual Cross Brace S S S S S S S S S S S S GDS Gussets for Dual Cross Brace S S S S S S S S S S PS Pivot Spreader Bar S S S S S S S S S GA Gussets for 5 /8'' Axle S S S S S S S S S GF-4 Gusseted Frame 4 Places S S S S S S 920 Suspension Fork S S S S S S 4244BK 24 x 1 /8'' Composite S S S S S S S S S S S S S S DA Deeper Arms S S S S S S S S S S S S S S page 4

5 250 lbs. and Under Very Active Depth 16'' & 17" 18'' & 19'' OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' RS Dual Seat Liner $49 S S S S S S S S S S S S S DS Dual Cross Brace $192 $192 $192 $192 $192 S S $192 $192 $192 $192 $192 S S GDS Gussets for Dual Cross Brace RB Dual Back Liner $49 S S S S S S S S S S S S S PERM Permanent Rear Uprights $40 $40 S S S S S $40 S S S S S S PS Pivot Spreader Bar S S S S GA Gussets for 5 /8'' Axle S S 58AS 5 /8'' Axle $99 $99 S S S S S $99 $99 S S S S S GCJ Gusseted Caster Journal $99 S S S S S S S S S S S S S GF-4 Gusseted Frame 4 Places 920 Suspension Fork 4244BK 24 x 1 /8'' Composite $108 $108 S S S S S $108 $108 S S S S S '' Semi-Pneumatic S S S S S S S S S S S TOTAL UPCHARGE $96 $79 $192 $192 $192 $0 $0 $79 $99 $192 $192 $192 $0 $0 OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' DS Dual Cross Brace $192 $192 S S S S S S S S S S S S GDS Gussets for Dual Cross Brace S S S S S S S S S S PS Pivot Spreader Bar S S S S S S S S S GA Gussets for 5 /8'' Axle S S S S $99 $99 S S S S S GF-4 Gusseted Frame 4 Places S S $285 $285 $285 S S S S 920 Suspension Fork S S $16 $16 $16 S S S S 4244BK 24 x 1 /8'' Composite S S S S S S S S S S S S S S DA Deeper Arms S S S S S S S S S S S S S S TOTAL UPCHARGE $192 $192 $0 $0 $0 $0 $0 $547 $547 $448 $0 $0 $0 $0 $ Amount = This option is required to meet user weight specifications. page 5

6 lbs. Depth 16" & 17'' 18'' & 19'' OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' RS Dual Seat Liner $49 S S S S S S S S S S S S S DS Dual Cross Brace $192 $192 $192 $192 $192 S S $192 $192 $192 $192 $192 S S GDS Gussets for Dual Cross Brace RB Dual Back Liner $49 S S S S S S S S S S S S S PERM Permanent Rear Uprights $40 $40 S S S S S $40 S S S S S S PS Pivot Spreader Bar S S S S GA Gussets for 5 /8'' Axle S S 58AS 5 /8'' Axle $99 $99 S S S S S $99 $99 S S S S S GCJ Gusseted Caster Journal $99 S S S S S S S S S S S S S GF-4 Gusseted Frame 4 Places 920 Suspension Fork 4244BK 24 x 1 /8'' Composite $108 $108 S S S S S $108 $108 S S S S S '' Semi-Pneumatic $56 $56 S S S S S $56 S S S S S S TOTAL UPCHARGE $942 $745 $192 $192 $192 $0 $0 $745 $99 $192 $192 $192 $0 $0 OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' DS Dual Cross Brace $192 $192 S S S S S S S S S S S S GDS Gussets for Dual Cross Brace S S S S S S S S S S PS Pivot Spreader Bar S S S S $200 $200 S S S S S GA Gussets for 5 /8'' Axle S S S S $99 $99 S S S S S GF-4 Gusseted Frame 4 Places S S $285 $285 $285 S S S S 920 Suspension Fork S S $16 $16 $16 S S S S 4244BK 24 x 1 /8'' Composite S S S S S S S S S S S S S S DA Deeper Arms S S S S S S S S S S S S S S` TOTAL UPCHARGE $192 $192 $0 $0 $0 $0 $0 $547 $547 $448 $0 $0 $0 $0 $ Amount = This option is required to meet user weight specifications. page 6

7 lbs. Depth 16'' & 17'' 18'' & 19'' OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' RS Dual Seat Liner $49 S S S S S S S S S S S S S DS Dual Cross Brace $192 $192 $192 $192 $192 S S $192 $192 $192 $192 $192 S S GDS Gussets for Dual Cross Brace $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 RB Dual Back Liner $49 S S S S S S S S S S S S S PERM Permanent Rear Uprights $40 $40 S S S S S $40 S S S S S S PS Pivot Spreader Bar $200 $200 $200 $200 $200 S S $200 $200 $200 $200 $200 S S GA Gussets for 5 /8'' Axle $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 S S 58AS 5 /8'' Axle $99 $99 S S S S S $99 $99 S S S S S GCJ Gusseted Caster Journal $99 S S S S S S S S S S S S S GF-4 Gusseted Frame 4 Places $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $ Suspension Fork $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $ BK 24 x 1 /8'' Composite $108 $108 S S S S S $108 $108 S S S S S '' Semi-Pneumatic $56 $56 S S S S S $56 S S S S S S TOTAL UPCHARGE $2024 $1827 $1224 $1224$1224 $82 $82 $1827 $141 $1224$1224$1224 $7 $7 OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' DS Dual Cross Brace $192 $192 S S S S S S S S S S S S GDS Gussets for Dual Cross Brace $285 $285 $285 $285 S S S S S S S S S S PS Pivot Spreader Bar $200 $200 $200 S S S S $200 $200 S S S S S GA Gussets for 5 /8'' Axle $99 $99 $99 S S S S $99 $99 S S S S S GF-4 Gusseted Frame 4 Places $285 $285 $285 $285 $285 S S $285 $285 $285 S S S S 920 Suspension Fork $16 $16 $16 $16 $16 S S $16 $16 $16 S S S S 4244BK 24 x 1 /8'' Composite S S S S S S S S S S S S S S DA Deeper Arms S S S S S S S S S S S S S S` RHB Reinforced Hanger Brackets $11 $11 $11 $11 $11 $11 $11 TOTAL UPCHARGE $1224 $1224 $102 $7 $448 $0 $0 $878 $878 $579 $11 $11 $11 11 $ Amount = This option is required to meet user weight specifications. page 7

8 01-50 lbs. Depth 16'' & 17'' 18'' & 19'' OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' RS Dual Seat Liner $49 S S S S S S S S S S S S S DS Dual Cross Brace $192 $192 $192 $192 $192 S S $192 $192 $192 $192 $192 S S GDS Gussets for Dual Cross Brace $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 RB Dual Back Liner $49 S S S S S S S S S S S S S PERM Permanent Rear Uprights $40 $40 S S S S S $40 S S S S S S PS Pivot Spreader Bar $200 $200 $200 $200 $200 S S $200 $200 $200 $200 $200 S S GA Gussets for 5 /8'' Axle $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 $99 S S 58AS 5 /8'' Axle $99 $99 S S S S S $99 $99 S S S S S GCJ Gusseted Caster Journal $99 S S S S S S S S S S S S S GF-4 Gusseted Frame 4 Places $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $285 $ Suspension Fork $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $16 $ BK24 x 1 /8'' Composite $108 $108 S S S S S $108 $108 S S S S S '' Semi-Pneumatic $56 $56 S S S S S $56 S S S S S S RHB Reinforced Hanger Brackets $11 $11 $11 $11 $11 $11 $11 $11 $11 $11 $11 $11 $11 $11 TOTAL UPCHARGE $2155 $1958 $155 $155$155$96 $96$1958$1962$155$155$155$864$864 OPTIONS Description Width <18'' 19'' 20'' 21'' 22'' 2'' 24'' <18'' 19'' 20'' 21'' 22'' 2'' 24'' DS Dual Cross Brace $192 $192 S S S S S S S S S S S S GDS Gussets for Dual Cross Brace $285 $285 $285 $285 S S S S S S S S S S PS Pivot Spreader Bar $200 $200 $200 S S S S $200 $200 S S S S S GA Gussets for 5 /8'' Axle $99 $99 $99 S S S S $99 $99 S S S S S GF-4 Gusseted Frame 4 Places $285 $285 $285 $285 $285 S S $285 $285 $285 S S S S 920 Suspension Fork $16 $16 $16 $16 $16 S S $16 $16 $16 S S S S 4244BK24 x 1 /8'' Composite S S S S S S S S S S S S S S DA Deeper Arms S S S S S S S S S S S S S S RHB Reinforced Hanger Brackets $11 $11 $11 $11 $11 $11$11 $11 $11 $11 $11$11$11$11 TOTAL UPCHARGE $155 $155 $116 $864 $579 $11 $11 $878 $878 $579 $11 $11 $11 $11 $ Amount = This option is required to meet user weight specifications. Invacare Corporation USA One Invacare Way Elyria, OH USA Invacare Yes, you can., Infinity, Smartleg and the Medallion Design are registered trademarks, and Absolute is a trademark of Invacare Corporation. Specifications and prices are subject to change without notification Invacare Corporation Form No Rev. 9/06

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS Invacare 900 series Suggested Canadian Price List Effective March 2nd, 2009 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS FRAME SELECTION ORDERING INFORMATION When ordering a 900 Series wheelchair, first select

More information

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS Invacare 9000 XT Wheelchair Suggested Canadian Price List Effective January 2nd, 2018 NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS Pre-Configured Stock Models Stock Chairs 9XT_PTO_29153 9XT/WD86/88-9000XT

More information

CareGuard by Invacare

CareGuard by Invacare Parts Catalog Issued: Jul 25, 2012 CareGuard by Invacare K2000 Standard K3000 Lightweight K4000 High Strength Lightweight K7000 Heavy Duty Wheelchairs Yes, you can. Parts Catalog Usage Guide The information

More information

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS FRAME SELECTION FRAME TYPE Seat angle is set at 3 degrees. See service manual for details. PATRIOT Folding Frame w/swingaway Front End $1,345 FRAME WIDTH W14 14'' Wide No Charge Not available with 18"

More information

Parts Catalog Issued: Nov 10, 2006

Parts Catalog Issued: Nov 10, 2006 Parts Catalog Issued: Nov 10, 2006 MX Yes, you can. Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for. If

More information

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018 TRACER EX2 FOLDING WHEELCHAIRS Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018 PROVIDER NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS Invacare Canada

More information

Parts Catalog Issued: Aug 1, Patriot. Wheelchair

Parts Catalog Issued: Aug 1, Patriot. Wheelchair Parts Catalog Issued: Aug 1, 2018 Patriot Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for. If

More information

Spare Parts Catalogue. Version: 2014/10/08b EN

Spare Parts Catalogue. Version: 2014/10/08b EN Spare Parts Catalogue TABLE OF CONTENTS Chassis Sideframes... Crossbrace... 5 6 Seat Seat Upholstery... Solid Seat Inserts..... 7 8 Backrest Legrests Back Cane Assemblies... 9 Back Upholstery... 10 Push

More information

SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT...3 SIDEFRAME (DETACHABLE ARM), CROSSBRACE...4 ARM, DETACHABLE...5 CASTER...5 REAR WHEEL...

SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT...3 SIDEFRAME (DETACHABLE ARM), CROSSBRACE...4 ARM, DETACHABLE...5 CASTER...5 REAR WHEEL... PARTS CATALOG CONTENTS SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT... SIDEFRAME (DETACHABLE ARM), CROSSBRACE... ARM, DETACHABLE...5 CASTER...5 REAR WHEEL...5 FRONT RIGGING, DETACHABLE...6 UPHOLSTERY

More information

Parts Catalog Issued: Mar 12, Comet Rocket. Wheelchairs

Parts Catalog Issued: Mar 12, Comet Rocket. Wheelchairs Parts Catalog Issued: Mar 2, 208 Comet Rocket Wheelchairs Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for.

More information

Parts Catalog Issued: Mar 26, Xterra GT. Power Wheelchair

Parts Catalog Issued: Mar 26, Xterra GT. Power Wheelchair Parts Catalog Issued: Mar 26, 2018 Xterra GT Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts

More information

Invacare TARSYS 2G POWER TILT/RECLINE Off Chair SYSTEMS ONLY Suggested Canadian Price List Effective March 1st, 2005 Revised June 18th, 2007

Invacare TARSYS 2G POWER TILT/RECLINE Off Chair SYSTEMS ONLY Suggested Canadian Price List Effective March 1st, 2005 Revised June 18th, 2007 Invacare TARSYS 2G POWER TILT/RECLINE Off Chair SYSTEMS ONLY Suggested Canadian Price List Effective March 1st, 2005 Revised June 18th, 2007 * UPDATED - DENOTES CHANGES NAME PHONE NO ACCOUNT # P.O. DATE

More information

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 PARTS CATALOG CONTENTS SIDEFRAME AND CROSSBRACE... ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 FRONT RIGGING, DETACHABLE... 6 UPHOLSTERY... 7 ACCESSORIES...

More information

For upholstery and frame color availability, please refer to the corresponding wheelchair price list.

For upholstery and frame color availability, please refer to the corresponding wheelchair price list. For upholstery and frame color availability, please refer to the corresponding wheelchair price list. Upholstery Frame U60 - Marina blue vinyl 08P - Deep purple 17P - Cobalt blue Invacare Corporation U86

More information

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 PARTS CATALOG CONTENTS SIDEFRAME AND CROSSBRACE... ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 FRONT RIGGING, DETACHABLE... 6 UPHOLSTERY... 7 ACCESSORIES...

More information

SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT...3 SIDEFRAME (DETACHABLE ARM), CROSSBRACE...4 ARM, DETACHABLE...5 CASTER...5

SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT...3 SIDEFRAME (DETACHABLE ARM), CROSSBRACE...4 ARM, DETACHABLE...5 CASTER...5 PARTS CATALOG CONTENTS SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT... SIDEFRAME (DETACHABLE ARM), CROSSBRACE... ARM, DETACHABLE...5 CASTER...5 UPHOLSTERY (ALL SIDEFRAMES)...6 FRONT RIGGING, DETACHABLE...6

More information

Parts Catalog Issued: Apr 11, Crossfire T6A. Wheelchair

Parts Catalog Issued: Apr 11, Crossfire T6A. Wheelchair Parts Catalog Issued: Apr, 208 Crossfire T6A Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for.

More information

Pronto M50 Pronto M51 with SureStep (Before 1/20/05)

Pronto M50 Pronto M51 with SureStep (Before 1/20/05) Parts Catalog Issued: Aug 30, 2018 Pronto M50 Pronto M51 with SureStep (Before 1/20/05) MWD Power Wheelchairs Parts Catalog Usage Guide The information contained in this document is subject to change without

More information

Invacare IVC Manual Wheelchair Series. Invacare IVC Manual Wheelchair Series

Invacare IVC Manual Wheelchair Series. Invacare IVC Manual Wheelchair Series Invacare IVC Manual Wheelchair Series Invacare IVC Manual Wheelchair Series For more than 0 years, Invacare has set the standard in manual wheelchairs for the HME industry. But our customers asked us to

More information

Pronto R2, Ranger II MWD for WSBT (After 2/29/2000)

Pronto R2, Ranger II MWD for WSBT (After 2/29/2000) Parts Catalog Issued: Aug 25, 2017 Pronto R2, Ranger II MWD for WSBT (After 2/29/2000) and Pronto R2 for PTO-PR & ESS6-PR Parts Catalog Usage Guide The information contained in this document is subject

More information

4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity)

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

More information

Parts Catalog Issued: Jan 8, Orbit. Wheelchair

Parts Catalog Issued: Jan 8, Orbit. Wheelchair Parts Catalog Issued: Jan 8, 2018 Orbit Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for. If

More information

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 PARTS CATALOG CONTENTS SIDEFRAME AND CROSSBRACE... ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5 FRONT RIGGING: FOOTREST, DETACHABLE... 6 FRONT RIGGING:

More information

VISTA IC PARTS CATALOG

VISTA IC PARTS CATALOG VISTA IC PARTS CATALOG Contents Sideframe (Fixed Arm), Crossbrace & Arm Pad Kit... Sideframe (Detachable Arm) & Crossbrace... Arm, detachable... 5 Upholstery (All sideframes)... 6 Front Rigging... 6 Caster...

More information

MVP / MVP jr. (After 10/15/01) Xtra (After 8/31/04)

MVP / MVP jr. (After 10/15/01) Xtra (After 8/31/04) Parts Catalog Issued: Apr 9, 2019 MVP / MVP jr. (After 10/15/01) Xtra (After 8/31/04) Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice.

More information

Standard Base Price: 618

Standard Base Price: 618 Manual Wheelchair Retail Prescription Form ACTION4NGHD11112016 Tel: 01656 776222 Fax: 01656 776220 JAN 2017 Email: ordersuk@invacare.com Online Spares available at: www.invacare.co.uk Customer Ref: Contact

More information

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151.

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151. This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada AADL CAT # 151 Effective 10/01/2018 Company: Account Number: Date: q Quote q PO Number:

More information

Parts Catalog Issued: Apr 11, Crossfire T7A. Adjustable Rigid Wheelchair

Parts Catalog Issued: Apr 11, Crossfire T7A. Adjustable Rigid Wheelchair Parts Catalog Issued: Apr, 08 Crossfire T7A Adjustable Rigid Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service

More information

Invacare Action 3 NG Transit Retail Max User Weight 125Kg (19.7 stone)

Invacare Action 3 NG Transit Retail Max User Weight 125Kg (19.7 stone) Manual Wheelchair Retail Prescription Form ACTION3NGTRANSIT10112016 Tel: 01656 776222 Fax: 01656 776220 JAN 2017 Email: ordersuk@invacare.co.uk Online Spares available at www.invacare.co.uk Customer Ref:

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) Freedom 2 Kids

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

More information

BEARINGS BEARINGS

BEARINGS BEARINGS TIRES PNEUMATIC.... 1-4 SNAP ON.....4 PRIMO HIGH PERFORMANCE......5-6 SCHWALBE HIGH PERFORMANCE.....5-6 KENDA HIGH PERFORMANCE... 7 MAINTENANCE FREE TIRES SHOX URETHANE TIRES..... 8 URETHANE TIRES....

More information

Parts Catalog Issued: Apr 10, Pronto M94 with SureStep

Parts Catalog Issued: Apr 10, Pronto M94 with SureStep Parts Catalog Issued: Apr 10, 2019 Pronto M94 with SureStep Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts

More information

Parts Catalog Issued: Jul 16, Arrow FWD. Power Wheelchair

Parts Catalog Issued: Jul 16, Arrow FWD. Power Wheelchair Parts Catalog Issued: Jul 16, 2018 Arrow FWD Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts

More information

Parts Catalog Issued: Apr 11, A-4 A-4 Titanium. (Wheelchairs Built After 9/15/02)

Parts Catalog Issued: Apr 11, A-4 A-4 Titanium. (Wheelchairs Built After 9/15/02) Parts Catalog Issued: Apr, 208 A-4 A-4 Titanium (Wheelchairs Built After 9/5/02) Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains

More information

W H E E L C H A I R S

W H E E L C H A I R S WHEELCHAIRS Value: Graham-Field is known for a broad product offering at affordable pricing, without sacrifice to quality. Like you, we understand that the cost of a product is more than a price tag. The

More information

Storm Series Power 9000 (After 11/14/1995)

Storm Series Power 9000 (After 11/14/1995) Parts Catalog Issued: Mar 2, 2017 Storm Series Power 9000 (After 11/14/1995) Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This

More information

AADL #W643 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

AADL #W643 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS FOR AADL ONLY AADL #W643 Invacare ProSPIN X4 Ultralightweight Active Performance Folder Suggested Canadian Price List July 1st, 2013 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS FRAME FRAME TYPE PROX4S X4

More information

BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

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

More information

STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

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

More information

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.

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. Funder: Order Number: Date: q Quote q PO Number: Therapist: Marked For: Catalyst 5 K5-CAT5-ALI 136kg weight capacity Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth

More information

Pronto M50 / M51 with SureStep (After 1/19/05) Pronto M61 with SureStep

Pronto M50 / M51 with SureStep (After 1/19/05) Pronto M61 with SureStep Parts Catalog Issued: Apr 19, 2017 Pronto M50 / M51 with SureStep (After 1/19/05) Pronto M61 with SureStep MWD Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject

More information

Storm Series Ranger II

Storm Series Ranger II Parts Catalog Issued: Mar 2, 2017 Storm Series Ranger II RWD Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains

More information

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

More information

Quickie QX July 2017

Quickie QX July 2017 Quickie QX July 2017 EIF6 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: Dealer

More information

Parts Catalog Issued: Apr 11, Power Tiger. Wheelchair

Parts Catalog Issued: Apr 11, Power Tiger. Wheelchair Parts Catalog Issued: Apr 11, 019 Power Tiger Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for.

More information

Standard Base Price: 539

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

More information

Invacare Action 3 Junior Basic RETAIL Max User Weight 80Kg (12.5 stone)

Invacare Action 3 Junior Basic RETAIL Max User Weight 80Kg (12.5 stone) 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

More information

Parts Catalog Issued: Mar 2, 2017 P7E. Power Wheelchair

Parts Catalog Issued: Mar 2, 2017 P7E. Power Wheelchair Parts Catalog Issued: Mar 2, 2017 P7E Power Wheelchair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for.

More information

Personal Care Commode

Personal Care Commode Parts Catalog Issued: Jun 2, 2009 Personal Care Commode Yes, you can. Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service

More information

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

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 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

More information

Parts Catalog Issued: Jul 16, At'm Chair

Parts Catalog Issued: Jul 16, At'm Chair Parts Catalog Issued: Jul 1, 018 At'm Chair Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog contains service parts for. If you have

More information

Quickie QX December 2018

Quickie QX December 2018 Quickie QX December 2018 EIF6 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV:

More information

Formula CG Tilt (CGT) Powered Seating

Formula CG Tilt (CGT) Powered Seating Parts Catalog Issued: Mar 12, 2018 Formula CG Tilt (CGT) Powered Seating TDX SC2-CG w/ TDX SC & TDX SPREE-CG w/ TDX SPREE Parts Catalog Usage Guide The information contained in this document is subject

More information

BC MEDEQUIP HOME HEALTH CARE LTD SPRINGER AVE, BURNABY, BC

BC MEDEQUIP HOME HEALTH CARE LTD SPRINGER AVE, BURNABY, BC Basic Wheelchair Bid Work Sheet HMEDA Member Name/Address: BC MEDEQUIP HOME HEALTH CARE LTD. 2230 Springer Avenue, Burnaby, BC, V5B 3M7 Contact Person: ANDRE MONTAGANO Phone/e-mail: 604-888-8811 andre@bcmedequip.com

More information

18 Wide. MRI Transport Wheelchairs. Overall Width: 26 Wheelchair, With Fixed Footrest. Specifications:

18 Wide. MRI Transport Wheelchairs. Overall Width: 26 Wheelchair, With Fixed Footrest. Specifications: MRI Transport Wheelchairs 18 Wide Overall Width: 26 Wheelchair, With Fixed Footrest Removable Full Length Padded Arms Fixed Footrests Seat To Floor Height: 19 1/4 Seat Width: 18 Overall Width: 26 Overall

More information

Invacare A4 Ultralight Active Performance Rigid

Invacare A4 Ultralight Active Performance Rigid Invacare A4 Ultralight Active Performance Rigid Price List and Order Form Effective January 15, 2008 Revised September 22, 2009 For ease of ordering, contact customer Service Toll Free at: 800-333-6900

More information

Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg

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

More information

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2,

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2, Quickie QXi AADL EIF6, October 2018 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City:

More information

4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by: Marked for: User manual: PO: Postal Code: Phone:

4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by:   Marked for: User manual: PO: Postal Code: Phone: 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: Vendor: Date: Ordered by: Email: Marked for: User

More information

STELLAR GL. Order Form - USA Prices in U.S. Dollars. January 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.

STELLAR GL. Order Form - USA Prices in U.S. Dollars. January 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. 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.070118 Shipping Address * * required F r a

More information

STELLAR. Order Form - USA Prices in U.S. Dollars. January 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.

STELLAR. Order Form - USA Prices in U.S. Dollars. January 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. 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

More information

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS STABLE

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS STABLE Invacare MyOn Active HD Folding Wheelchair AADL Customers Only AADL # W155 Effective October 1, 2018 NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS FRAME SELECTION FRAME TYPE MYONAC MyOn Active Folding Wheelchair

More information

Formula CG Tilt (CGT) Powered Seating

Formula CG Tilt (CGT) Powered Seating Parts Catalog Issued: Jan 8, 2018 Formula CG Tilt (CGT) Powered Seating For TDX SI Parts Catalog Usage Guide The information contained in this document is subject to change without notice. This catalog

More information

Invacare Action 3 Junior Large Retail Max User Weight 80Kg (12.5 stone) Standard Base Price: 539 * Configurations may vary to the image shown

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:

More information

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan.

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan. MASS Script Form Australian Order Form Effective 05/07/2014 Company: Account Number: Date: Quote PO Number: RTS: Marked For: Ship To: Address: City: State: Zip: Phone: Email/Fax: Catalyst 5Vx K0005 Charge

More information

October 2018 EIQ2X. Mark For: Submitting for: Quote Order. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Price. Option # 1. FRAME 002RS1 002RS2

October 2018 EIQ2X. Mark For: Submitting for: Quote Order. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Price. Option # 1. FRAME 002RS1 002RS2 Quickie 2 October 2018 EIQ2X Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV:

More information

Account Number: Provider Name: Contact:

Account Number: Provider Name: Contact: Quantum Rehab Discount: Terms: Freight: Taken By: DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered

More information

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required MVMA053 MVMA056. MVMA058 English Manual (STD) Dutch Manual

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required MVMA053 MVMA056. MVMA058 English Manual (STD) Dutch Manual 160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 orders@motioncomposites.com www.motioncomposites.com 4.8 MOVE ORDER FORM - INTERNATIONAL P.O.

More information

Invacare A4 Titanium Ultralightweight Active Performance Rigid

Invacare A4 Titanium Ultralightweight Active Performance Rigid Price List and Order Form For ease of ordering, contact Customer Service Toll Free at: 800-333-6900 Fax: 800-678-4682 To order Literature: 800-828-6282 Effective July 1, 2008 rev September 22, 2009 www.invacare.com

More information

MEDmobility Calgary Trail NW Edmonton AB T6H 2K1 P: F:

MEDmobility Calgary Trail NW Edmonton AB T6H 2K1 P: F: Canada MEDmobility 5711- Calgary Trail NW Edmonton AB T6H 2K1 P: 780-437-3300 F: 780-430-9381 www.medmobility.ca Company: Account Number: Date: Quote PO Number: RTS: AADL #W154 Effective 10/01/2017 Ship

More information

For AADL Only AADL Cat. #W558

For AADL Only AADL Cat. #W558 For AADL Only AADL Cat. #W558 Invacare 3G Storm TORQUE SP-LE Maxx Rehab Seat Power Wheelchair Suggested Canadian Price List Effective October 1, 2018 DEALER : ACCOUNT#: DEALER CONTACT: PHONE #: P.O. #:

More information

Quickie GTX Fixed Frame EIF3, Effective July 2009

Quickie GTX Fixed Frame EIF3, Effective July 2009 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

More information

Invacare A4 Ultralight Active Performance Rigid

Invacare A4 Ultralight Active Performance Rigid Invacare A4 Ultralight Active Performance Rigid Price List and Order Form Effective January 15, 2008 Revised April 9, 2008 For ease of ordering, contact customer Service Toll Free at: 800-333-6900 Fax:

More information

USA Parts List BENTLEY

USA Parts List BENTLEY USA Parts List BENTLEY Effective January 1, 2018. Prices in U.S. Dollars. Prices and descriptions contained in this manual are subject to change without prior notice. Bentley Frame-Seat Pan Floor Jack

More information

Personal Care Commode

Personal Care Commode Parts Catalog Issued: Jan 23, 2004 Personal Care Commode Yes, you can. PARTS CATALOG USAGE GUIDE The information contained in this document is subject to change without notice. This catalog contains service

More information

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: City: Province:

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: City: Province: 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 orders@motioncomposites.com www.motioncomposites.com 4.2 Helio C2 ORDER FORM - CANADA

More information

Wheelchair, foldable heavy duty

Wheelchair, foldable heavy duty SPARE PARTS MANUAL WHEELCHAIRS Sideguard 2 5 6 7 4 8 9 0 0 95024 Sideguard, heavy duty, right pc. 02 9502 Sideguard, heavy duty, left pc. 0 42002 Sideskirt black, right pc. 04 4200 Sideskirt black, left

More information

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: Phone:

4.2. Ship to: Vendor: Name: Date: Address: Ordered by:   Phone: 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 orders@motioncomposites.com www.motioncomposites.com 4.2 MOVE ORDER FORM - CANADA

More information

MEDIchair Northern BC nd Avenue Prince George, British Columbia V2L 3A6 Toll Free

MEDIchair Northern BC nd Avenue Prince George, British Columbia V2L 3A6 Toll Free MEDIchair Northern BC 849 2 nd Avenue Prince George, British Columbia V2L 3A6 Toll Free 1-800-330-2772 BC Ministry of Health A Cheat Sheet for Clinicians Included Features for a Basic Wheelchair, Basic

More information

Quickie 2 EIQ2N Effective April 2011

Quickie 2 EIQ2N Effective April 2011 Quickie 2 EIQ2N Effective April 2011 ACCOUNT #: SHIP TO: DATE: NAME: P.O. #: ADDRESS: BUYER: CITY/ STATE: MARKED FOR: ZIP CODE: PHONE NUMBER: The HCPCS codes provided are based on code verification by

More information

RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"

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

More information

Frame. Backrest. Seat Depth. Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time free growth kit. 165 lb weight capacity.

Frame. Backrest. Seat Depth. Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time free growth kit. 165 lb weight capacity. Canada Patent Pending AADL #W157 Effective 10/01/2017 Company: Ship To: Account Number: Date: Quote PO Number: RTS: Marked For: Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time

More information

Account Number: Provider Name: Contact:

Account Number: Provider Name: Contact: Discount: Terms: Freight: Taken By: Quantum Rehab A Division of Pride Mobility Products Corporation 82 Susquehanna Ave., Exeter, PA 8643 Phone: (866)800-2002 Fax: (866) 707-3422 DME providers are responsible

More information

Quickie IRIS January 2014

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: ( )

More information

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

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:

More information

Index. By Chair Model. Accessory Cushions & Parts. Seat & Back Pads. Positioning Belts. Trays. Footrests. Cylinders & Cables. Stabilizers/Anti-Tippers

Index. By Chair Model. Accessory Cushions & Parts. Seat & Back Pads. Positioning Belts. Trays. Footrests. Cylinders & Cables. Stabilizers/Anti-Tippers Parts & Accessories Index By Chair Model Accessory Cushions & Parts Seat & Back Pads Positioning Belts Trays Footrests Cylinders & Cables Stabilizers/Anti-Tippers Page Elite 2 MIDLINE 3 30VT 4 Pedal Chair

More information

USA Parts List FUZE T50

USA Parts List FUZE T50 USA Parts List FUZE T50 Effective January 1, 2018. Prices in U.S. Dollars. Prices and descriptions contained in this manual are subject to change without prior notice. Fuze T50 Frame-Seat Pan Cross Bar

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair PRO-CG Adult Manual Wheelchair email: customerservice@freedomdesigns.com TM SE Clear Form Email Form to Customer Service Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Notice: A seating

More information

Quickie IRIS FSS Net Order Form/Price List (SIN F-1)

Quickie IRIS FSS Net Order Form/Price List (SIN F-1) Mark For: Date: Dealer Acct #: Dealer: Dealer Contact: Dealer Address: Dealer City: ST: Dealer Phone: ( ) Fax: ( ) Confirmation Email: Confirm Via: ZIP: Quickie IRIS FSS Net Order Form/Price List (SIN

More information

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 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.

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 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. 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.070118 Shipping Address * * required F r a

More information

FUZE T50. Order Form USA. Please send your completed order form by to or by fax to

FUZE T50. Order Form USA. Please send your completed order form by  to or by fax to Page 1 of 5 Purchase Order Tag Dealer/Organization Name Purchaser Name and Contact Information Mailing Address Shipping Address Please send your completed order form by email to info@pdgmobility.com or

More information

Transformer. Rev C. Aug 15, 2010 Page 1 of 8

Transformer. Rev C. Aug 15, 2010 Page 1 of 8 Transformer Rev C. Aug 15, 010 Page 1 of 8 www.topendwheelchair.com Rev C. Aug 15, 010 Page of 8 www.topendwheelchair.com ITEM PART NUMBER PER CHAIR DESCRIPTION 1 1116570 1 Upper Seat Frame, specs required

More information

BREEZY EC... 4 BREEZY EC (2000, 2000HD, 3000, & 4000)... 4 BASE FRAME... 4 FRAME FRAME FRAME (FIXED ARMREST)...

BREEZY EC... 4 BREEZY EC (2000, 2000HD, 3000, & 4000)... 4 BASE FRAME... 4 FRAME FRAME FRAME (FIXED ARMREST)... BREEZY EC PAGE 1 BREEZY EC... 4 BREEZY EC (2000, 2000HD, 3000, & 4000)... 4 BASE FRAME... 4 FRAME... 4 1000 FRAME... 4 2000 FRAME (FIXED ARMREST)... 5 2000 & 3000 FRAME (REMOVABLE ARMREST)... 6 2000 HD

More information

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair P.R.O. CG Adult Manual Wheelchair TM SE 2241 N Madera Rd Simi Valley, CA 93065 Phone: (800) 331-8551 Fax: (888) 582-1509 www.freedomdesigns.com email: customerservice@freedomdesigns.com Date: Buyer: Company:

More information

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS Print Form Save Form Submit Form Clear Form Contents Invacare TDX SP Rehab Seat Power Wheelchair Suggested Canadian Price List Effective July 25, 2017 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS BASE CHAIR

More information

Transport Chairs / Walkers MRI Transport

Transport Chairs / Walkers MRI Transport MRI Folding Walkers 18 Wide, Depth 17 250 lb weight capacity WA-1000 Adult - 32 to 36 $195.00 ea. WA-1001 Junior - 28 to 32 $195.00 ea. MRI Heavy Duty / Extra Wide Folding Walker 24 Wide, Depth 21 500

More information

NXT Pediatric. Manual Wheelchair. Transport Optional Base

NXT Pediatric. Manual Wheelchair. Transport Optional Base Pediatric Manual Wheelchair Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Transport Optional Base Folding (E1234) NXT-30300 $2800 Transport Optional Note: Transportation Option selected

More information

ZIPPIE IRIS (Transit Included) EIZ5A

ZIPPIE IRIS (Transit Included) EIZ5A ZIPPIE IRIS (Transit Included) EIZ5A MASS QLD ORDER FORM SUMMARY PAGE Effective: January, 2014 ORDERING INFORMATION: (02) 9678 6600 Fax: (02) 9678 6655 Email:orders@sunrisemedical.com.au Date: Sales Rep:

More information

q Little Wave Flip XP - Rigid Base KF-XPRIGID $

q Little Wave Flip XP - Rigid Base KF-XPRIGID $ Phone 0800 5 222 Fax 0800 275 65 Effective /06/207 Funder: Account Number: Date: Quote PO Number: Therapist: Marked For: Little Wave Flip XP - Rigid Base KF-XPRIGID $ 9.8kg weight capacity. One time free

More information

Formula TRE Powered Seating Front Riggings & MK5 Electronics

Formula TRE Powered Seating Front Riggings & MK5 Electronics Parts Catalog Issued: Aug 27, 2018 Formula TRE Powered Seating Front Riggings & MK5 Electronics TDX Power Wheelchairs Parts Catalog Usage Guide The information contained in this document is subject to

More information