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.
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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 * Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Tag v Shipping Address * * required F r a m e T y p e Fuze T20 20 Manual Tilt Wheelchair 3,995 F r a m e O p t i o n s Fixed Base and Seat Frame 250 lbs Weight Capacity. Select Fixed Seat Width below Adjustable Base and Seat Frame 250 lbs Weight Capacity. Select Adjustable Seat Width below Transit Tie Down System (TTDS) TTDS includes 4 factory-installed transport brackets. TTDS has been tested according to ANSI/RESNA WC 19. See Owners Manual for complete details. User Weight Range Required for selection of Gas Struts (Force measured in Newton - N) Up to 150 lbs (600 N) lbs to 200 lbs (1000 N) lbs to 250 lbs (1200 N) 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 Fixed Seat Widths Order with Fixed Base and Seat Frame " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width " Seat Width 215 Adjustable Seat Widths Order with Adjustable Base and Seat Frame "-15" Range - Set at 12" "-15" Range - Set at 13" "-15" Range - Set at 14" "-15" Range - Set at 15" "-20" Range - Set at 15" "-20" Range - Set at 18" "-20" Range - Set at 16" "-20" Range - Set at 19" "-20" Range - Set at 17" "-20" Range - Set at 20" "-22" Range - Set at 21" "-22" Range - Set at 22" 215 S e a t D e p t h Standard Seat Depths (Adjustable) " Seat Depth " Seat Depth " Seat Depth " Seat Depth " Seat Depth " Seat Depth F r a m e C o l o u r PDG Premium Colours Tracer Red Black Shimmer Blue Shimmer Geyser Green Bubble Gum Pink Gloss Black Orange Fusion Gloss White Lollypop Blue Berry Purple Silver Karl s Imagination Dark Titanium Lollypop Red 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 info@pdgmobility.com 1 / 6
2 A r m T y p e No Armrest Single Post Fixed Height (12") Single Post Adjustable Height 8"-11" not compatible with 22" and 24" Rear Wheels "-11" "-14" Dual Post Fixed Height (12") Full Length Armpad only. Dual Post Adjustable Height 8"-11" not compatible with 22" and 24" Rear Wheels "-11" "-14" "-16" Locking Flip-up Not recommended for users with excessive strength or tone. Not compatible with Fold Down Back, 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 Curved Armpads Not compatible with Lap Tray, Locking Flip-up Armrests, Dual Post Armrests,22" and 24" Rear Wheels. 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") S e a t P a n No Seat Pan Solid Aluminum 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 info@pdgmobility.com 2 / 6
3 S e a t H e i g h t Select desired Seat-to-Floor Height Standard T20 Options Narrow T20 Options RW 5" Casters Reduces the overall width of the Chair by 2". 12" 13" Recommended only if the width of the chair is a 16" 13" 14" 15" concern. Some STF combinations offer less than 20 of tilt, but all offer a minimum of " 13" 14" 15" 16" 17" 22" 14" 15" 16" 17" RW 5" Casters 24" 15" 16" 17" 12" 13" 14" 16" 14" 15" 16" RW 6" Casters & 6" Forks 20" 16" 17" 16" 14" 15" 22" 17" 20" 14" 15" 16" 17" 22" 14" 15" 16" 17" 18" RW 6" Casters & 6" Forks 24" 15" 16" 17" 18" 12" 14" 16" 14" 15" 16" RW 6" Casters & 8" Forks 20" 16" 17" 18" 16" 15" 22" 17" 18" 20" 15" 16" 17" 24" 18" 22" 15" 16" 17" 18" 24" 15" 16" 17" 18" 19" RW 6" Casters & 8" Forks 16" 15" 16" RW 8" Casters & 8" Forks 20" 16" 17" 18" 20" 16" 17" 22" 17" 18" 19" 22" 16" 17" 18" 24" 18" 19" 24" 16" 17" 18" 19" RW 16" 8" Casters & 8" Forks 16" 20" 16" 17" 18" 22" 17" 18" 19" 24" 18" 19" 20" Standard Narrow Wheel size Caster size Fork size STF height Urethane 5" x 1.25" Caster size 6" x 1.25" Caster size 6" x 1.50" Caster size 8" x 1.25" Caster size " x 2.00" Caster size Pneumatic 6" x 1.25" Caster size 8" x 1.25" Caster size " x 2.00" Caster size " Soft Roll 95 Composite " Wheel size " Wheel size " Wheel size " Wheel size C a s t e r s R e a r W h e e l s " Wheel size Spoke " Wheel size " Wheel size " Wheel size " Heavy Duty Spoke 350 A x l e T y p e Quick Release Rear Axles Fixed Rear Axles PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone info@pdgmobility.com 3 / 6
4 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 Push to Lock Pull to Lock Attendant Wheel Lock (Push to Lock) Not compatible with Wheel Lock Extensions User & Attendant Wheel Lock Wheel Lock Extensions Not compatible with Attendant Wheel Lock Rear Anti-Tippers Required Safety Option Push Bar Back Straight Bend 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 Cane Handle Back Straight Not compatible with Headrest Mounting Plate Bend 75 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 Removable Cane Handle Push Bar Not compatible with Push Bar Back. 140 Seat to Back Angle Set at Set at Set at Set at Set at Set at Fold Down Back Non Fold Down Back 75 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. Not available with Cane Handle Back Set at 18" Set at 19" Set at 20" Set at 21" Set at 22" Set at 23" Adjustable Tension Back height measured from Seat Pan to top of Upholstery. Not available with Cane Handle Back Set at 21" Set at 22" Set at 23" PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone info@pdgmobility.com 4 / 6
5 B a c k r e s t No Backrest nxt Xtend "-20" width, 16"-20" height "-24" width, 16"-20" height 720 nxt Xtend Deep "-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 H e a d r e s t No Headrest Headrest Mounting Plate 75 Not compatible with Angle/Height Adjustable Push Bar, Cane Handle Back. Not required if mounting to a solid Back nxt MultiFit Head Support Hardware 235 nxt MultiFit Head Support Pad Regular (9" x 5") Large (10" x 5") X-Large (14" x 5") F r o n t R i g g i n g No Front Rigging Sector Blocks only PDG Easy-Out TM Front Rigging Effortless insertion and removal. No Hanger Bracket remains on frame Fixed Swing In/Away Universal Angle Adjustable (0-110 ) Set at (use increments of 10 ): Swing In/Away Elevating Legrests High knee pivot. Includes reinforced premium Calf Pad mount. 495 Standard Front Rigging Legacy Design. Not compatible with Easy-Out TM Swing Away Swing Away 90 Not compatible with 8" Casters Swing Away Elevating Legrest " Offset Hangers for Swing Away 75 F o o t P l a t e s Composite Aluminum Angle Adjustable Interlocking Angle Adjustable Seat Widths of 14"-21" only. 195 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 70 Calf Pad Not compatible with 70 Gel Padding Swing Away 70 Gel Padding Not compatible with 70 Swing Away Calf Pad, Easy-Out Front Rigging Swing Away ELR Gel Knee Pad Adjustable Length Heel Loops Bodypoint - Padded Calf Strap 105 PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone info@pdgmobility.com 5 / 6
6 Short 14"-18" for Easy-Out Fixed & SA Angle Adjustable 11"-15" for Easy-Out SA ELR 13"-17" for Standard Front Rigging Long 18"-24" for Easy-Out Fixed & SA Angle Adjustable 15"-21" for Easy-Out SA ELR 15"-19" for Standard Front Rigging For 90 FR (11"-16") Not compatible with Easy-Out, Standard 70 or ELR Lap Belt Mount E x t e n s i o n T u b e s 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 Gel Hip Guides Not compatible with Dual Post Arms. Reduces available Seat Width by 2" IV Pole 15" STF and higher O2 Holder 15" STF and higher Clear Lap Tray (Slide On) Not compatible with 8-11 Dual Post, Curved Armpads, Contour Arm Trough. Seat Widths of only. 490 Premium Grade or Gel Armpads recommended to ensure snug fit of the Tray Adhesive Back Hook Strip, 2" x 30" For Cushion mounting Fuze T20 to T50 Conversion Kit O r d e r N o t e s Please send your completed order form by to info@pdgmobility.com or by fax to Scan this code or go to pdgmobility.com/products/fuze-t20/ to learn more about the Fuze T20 20 Manual Tilt Wheelchair PDG Product Design Group Inc. 318 East Kent Ave South Vancouver BC V5X 4N6 Canada Phone info@pdgmobility.com 6 / 6
FUZE T20. 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 * Tag v.070118 Dealer/Provider Name * Purchaser Name and Contact Information * Billing Address * Shipping Address * * required F r a
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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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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:
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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
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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
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 Helio A7 ORDER FORM - INTERNATIONAL P.O.
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio A6 ORDER FORM - INTERNATIONAL P.O.
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160 Armand-Majeau Sud Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.7 Helio A6 ORDER FORM - CANADA P.O. number:*
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2915 Ogletown RD # 2270 Newark, DE 19713 T.+1-866-650-6555 F. +1-888-966-6555 orders@motioncomposites.com www.motioncomposites.com 4.8 Helio ORDER FORM - USA P.O. number:* Date: Ship to:* Company Name:*
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