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1 Discount: Terms: Freight: Taken By: Quantum Rehab A Division of Pride Mobility Products Corporation 82 Susquehanna Ave., Exeter, PA 8643 Phone: (866) Fax: (866) DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered as legal advice. All prices are MSRP. BASE OPTIONS Litestream XF $, K lbs. Weight Capacity, Allows Seat-To-Floor Heights ADDITIONAL BASE OPTIONS Ultra Hemi Package $20 K lbs. Weight Capacity, Allows Seat-To-Floor Heights Heavy Duty Package 2 $495 K008 Increases Weight Capacity To 350lbs, Available 8-22 W. Not available with HD Package or Occupied Transit Kit D-7 D Requires SOF. Not available with Occupied Transit Kit. COLOR SELECTION Metallic Colors: N/C Solid Colors: N/C Cosmic Silver Green Mantis Pacific Blue Pink Flamingo Rainforest Green Arctic White Plum Crazy Orange Crush Purple Haze Red Hot Blue Sky.Extended 2 day lead time. Black Abyss Yellow Sunshine.Extended 2 day lead time. Custom Prints: $795 Winter Camo Digital Woodland Camo Digital Marine Camo American Flag Woodland Camo Pink Camo Mossy Oak Snake Skin Digital Army Camo SEATING DIMENSIONS Width: 4 W 5 W 6 W 7 W 8 W 9 W 20 W 2 W 22 W $450 E220 Depth: 4 D 2 5 D 2 6 D 2 7 D 8 D 9 D 20 D $500 E2203 Frame Length: 6 (4 D-6 D) 8 D (6 D-8 D) 20 D (8 D-20 D). Requires HD package D-7 D with HD package requires SOF. AXLE PLATE AND CAMBER 3 Single Slot Axle Plate Camber: No Camber.5 o Camber 3 o Camber -Arm Drive, 3 Single Slot Axle Plate $795 E0958 Amputee Axle Plate 2 $75 Camber: No Camber.5 o Camber 3 o Camber. Dual Post, Flip Back Armrests are not available with Camber. 2. Not available with HD Package or Occupied Transit Kit Account Number: Provider Name: Contact: Phone: Fax: Date: PO#: Marked For: Ship To Address: City: State: Zip: SEAT-TO-FLOOR HEIGHT Rear Seat-To-Floor Can Not Be Higher Than Front Seat-To-Floor Height Quick Release Fork Allows For A Maximum Dump Of 2 Bolt-On Fork Allows For A Maximum Dump Of 2.5 Front: Rear: ARMRESTS No Armrests Armrests: Tubular, Swing-Away, 2 L, 0- H Height Adjustable, 0 H-4 H, Removable, $275 E0973 Drop-in Dual Post, Flip Back, Removable, Height- $245 E0973 Adjustable, ,2 Armpads: Straight Armpads Size: Desk Length Full Length Waterfall Armpads 3 Size: Desk Length Full Length. Not available with Occupied Transit kit. 2. Not available with Camber. Can not adjust to lower than 2.5 H when used with 24 or 26 rear wheels set in highest axle position. 3. Not available w/ dual post armrests. WHEEL LOCKS Push-to-Lock Push-to-Lock Extensions 2 $75 E096 Pull-to-Lock Pull-to-Lock Extensions $75 E096 Hill Holder (Push to Lock) 3 $295 E0974 Scissor Locks 2 $95 Unilateral Wheel Lock System 4 $29 Left Side Right Side. May interfere with ELR s. 2. May interfere with Full Length Arms. 3. Not available with polyurethane tires. 4. Must Use Tubular or Flip-Up Height Adjustable Armrests. Not available with Side Guards. Not available with poly tires. WHEEL LOCK CLAMP Standard Extended WHEEL TYPE Pre-Configured Wheels See Page 2 Build-To-Order Wheels See Pages 2 & 3 Revised: August 25, 204 Page of 6

2 BACK CANES HEADREST 8 o Back Canes w/ Push Handles Size: 2-6 H 5-9 H Straight Back Canes Size: 2-6 H 5-9 H Handles: With Push Handles o Without Push Handles Straight Reinforced Canes 5-9 H w/ Push Handles Angle-Adjustable Back Canes 2 $64 Size: 2-6 H 5-9 H Handles: With Push Handles o Without Push Handles Only compatible with Shape Back. Not configurable, must be line itemed. Refer to Positioning Components for details and part numbers. Stealth: Small (9.75 W x 3 H) $205 E0955 Large ( W x 6 H) $205 E0955 Small Comfort Plus (0 W) $205 E0955 Large Comfort Plus (4 W) $205 E0955 Removable Headrest Bracket $20 E028 Swing-away (Flip-down) Headrest Bracket $20 Interfaces with any headrest that uses /2 square down-tube. REAR SEAT-TO FLOOR HEIGHT CHART. Not available with HD package. 2. Not available with Occupied Transit Kit BACK OPTIONS Padded Sling Back Tension Adjustable Seat Back $350 E26 22 W Tension Adjustable Seat Back $465 E262 Synergy Shape GP Back (9 H) Width: 4 W 6 W 8 W 20 W $465 E26 22 W $485 E262 Synergy Shape Back Hardware: 2-Point 4-Point Height: Standard (9 H) Width: 4 W 6 W 8 W 20 W $495 E W $595 E264 Synergy Shape Deep Contour Height: Medium Tall Width: 4 W 6 W 8 W 20 W $595 E W $695 E262 Omit Backrest (-$5) Comfort Company Back Various. Not available with Occupied Transit Kit. MILITARY BACK PATCHES (FOR TENSION ADJUSTABLE BACK) Branch Patches: See Comfort Company U.S. Air Force U.S. Marines Drive Wheel Rear STF 20" 2.5" - 6" 22" 3.5" - 7" 24" 4.5" - 8" 25" 5" - 8.5" 26" 5.5" - 9". When 25 rim is used with 26 mountain bike tire the STF height for 26 wheel applies. PRECONFIGURED WHEEL ASSEMBLIES Includes Rim, Handrim and Tire For Customized Configurations See The Following Sections Mag w/ Aluminum Handrim & 3 /8 Poly- -urethane Tire Heavy Duty 24 Wheels w/ Aluminum Handrim and Flat-Free Insert Mag w/ Vinyl Coated Handrim & 3 /8 Poly- $200 E228 -urethane Tire One-Arm Drive Wheels,2 w/ 24 Lightweight Quick- Release Wheel w/ Aluminum Handrim and Pneumatic Tire 24 Mag w/ Vinyl Coated 45 o Projection- $295 E228 Handrim & 3 /8 Polyurethane Tire Spinergy Wire Spokes w/ Aluminum Handrim, & 3 /8 Everyday Gray Tire Size: 22 $ $ Magic Wheels 2-Speed Geared $5,495 E2227 U.S. Army U.S. Navy. Not available with HD package. 2. Requires 3 Single Slot Axle Plate for -Arm Drive. Not available with Occupied Transit Kit. U.S. Coast Guard Purple Heart Patch: Purple Heart Revised: August 25, 204 Page 2 of 6

3 BUILD TO ORDER WHEEL CHARTS Rear Seat-To-Floor Height: Tire/Rim Compatability: Tires Drive Wheel Mag Spinergy Wire Spoke Rear STF 20" 2.5" - 6" 22" 3.5" - 7" 24" 4.5" - 8" 25" 5" - 8.5" 26" 5.5" - 9" Rim Everyday Gray 20, 22, 24 20, 22, 24, , 22, 24, 25 24, Knobby 24 24, , 26 24, 26 Poly Touring 20, 22, 24 N/A N/A N/A N/A 45 psi Schwable N/A 24, 25, , 25, 26 24, 25, " Knobby N/A 25" N/A psi Primo N/A 22, 24, , 24, 26 24, 26 Primo 20, 22, 24 20, 22, 24, , 22, 24, 26 24, 26. When 25 rim is used with 26 mountain bike tire the STF height for 26 wheel applies. RIMS WITH HANDRIMS Spinergy Flex Rim Spinergy Lite Extreme Must Select Tire In Addition To Rim w/ Handrim. Mag w/ Alum. Handrim, 24 Spinergy Wire Spokes w/ Alum. Handrim, 24 Spinergy Wire Spokes w/ Natural Fit Handrim, 24 $395 Spinergy FlexRim, 24 $995 RIMS WITH TIRES Must Select Handrim In Addition To Rim w/ Tire. Mags w/ 3 /8 Gray Everyday Flat Free Tire $75 E223 RIMS Sport Lite Extreme TIRES Must Select Rim & Handrim In Addition To Tires. Consult Tire/Rim Compatability Chart On Page 2. 3 /8 Gray Everyday Use Tire Tube Type: Pneumatic o Flat Free $45 E /8 Gray Knobby Tire Tube Type: Pneumatic o Flat Free $45 E223 Size: /8 Polyurethane Full Profile Touring Tread $80 E228 Color: Dark Charcoal Gray Everyday Light Gray (24 Only) 25 Schwable 45 PSI Tube & Tire 2 $80 Color: Black, Marathon Plus Evolution Gray, Marathon Plus Size: x 2.0 Knobby Mountain Bike $45 Pneumatic Tire & Tube 3 Color: Black Gray /4 Gray Primo 0 PSI V-Trac Pneumatic Tire & Tube $95 Size: Color: Gray Red (24 & 26 Only) Yellow (24 & 26 Only) Blue (24 & 26 Only). Not available with HD package. 2. Must be used with spoke wheels. 3. Not available with HD package. Must use 25 spoke wheels. HANDRIMS Must Select Tire and Rim In Addition To Handrim. Handrim Must Match Rim Size For Any Rims: Anodized Aluminum Size: Vinyl Coated Aluminum $ Projection Handrim $95 Style: 45 o Oblique Vertical For Spoke Rims Only: Natural Fit Handrim Grip: Standard Grip $345 Super Grip $395 Size: Natural Fit LT Handrim Grip: Standard Grip $345 Super Grip $395 For Mag Rims Only: Chrome Handrim. Not available with spoke protectors. Must Select Handrim & Tire In Addition To Rims. Mags Spinergy Lite Extreme Carbon Fiber Spokes (2 Spoke) $895 Size: Color: Blue Black White Yellow Red Green o Pink Orange Spinergy Sport Lite Extreme Carbon Fiber Spokes (24 Spoke) $895 Size: Color: Blue Black White Yellow Red Green Pink Orange Spinergy Wire Spokes $ Revised: August 25, 204 Page 3 of 6

4 FRONT SEAT-TO-FLOOR HEIGHT/CASTER CHARTS S = Short Fork L = Long Fork F = Frog Legs CASTER WHEELS (CONT D) Caster Size Standard Seat-to-Floor Heights S3 S2 S/F3 L3/F2 L2/F L 5 S2 S/L4 L3/F2 L2/F L 6 S/L4 L3 L2/F L 8 L2 L 6 Casters 3 : Black Urethane.5 W, 3 Spoke Flat Free Smooth Black Soft Roll.5 W, 3 Spoke Alum. Rim, Smooth Polyurethane $230 Gray Pneumatic.25 W, 3 Spoke, Treaded Tire $85 8 Casters 4 : Black Urethane.5 W, 3 Spoke Flat Free Smooth Gray Pneumatic,5 2 W, 3 Spoke, Threaded Tire $85 Caster Size Ultra Hemi Seat-to-Floor Heights S2 S/F3 L3/F2 L2/F L 5 S2 S/L4 L3/F2 L2/F L 6 S/L4 L3 L2/F L 8 L2 L Short Fork Hole Configuration Long Fork 3. 6 casters can not be used with 90 degree legrests. If an HD package is chosen with Frog Legs you must choose a 6 caster and can only achieve an 8 STF height casters can not be used with 90 degree or 80 degree legrests W caster wheels must be used with 2 W Tall Fork. AXLE SELECTION Quick Release Quad Release $90. Not available with HD package. Cosmetic cover will be removed w/ Mag wheel configuration. BI-DIRECTIONAL FOOT RIGGINGS Refer To Charts On Page 5 For Maximum Availble Leg Length Chart Aluminum Swing-Away Legrests Style: 60 o 70 o 70 o Tapered 80 o 2 90 o 3 Elevating Legrests 4 $295 E0990 Calf pad: Standard Offset Depth Adjustable CASTER FORKS Fork: Short Fork Long Fork Quick Release Bolt-On CASTER WHEELS Quick Release Bolt-On 2 W Long Fork, Quick Release Frog Legs 2 $395 E05 Frog Legs Unitine Fork 3 $249 E05 Accessories: Extended Stem Bolt For Increased Front STF Height 4 Allows For A Maximum Dump Of 2.5 With Bolt-On Fork Only.75 Higher.5 Higher Caster Pin Locks For Bolt-On Fork $95 K0073 Short Fork Long Fork. 2 W Tall Fork is required with 2 W Casters. 2. If an HD package is chosen with Frog Legs you must choose a 6 Caster and can only achieve an 8 STF Height. 3. For Frog Legs Unitine Fork Seat-To-Floor Heights use Short Fork holes 2 & 3 (S2 & S3). Not available with HD package. 4. Only available through SOF. Not available with HD package. 4 Casters : Lighted Caster W, 0 Spoke, Clear Acrylic Smooth, Flat Free $68 Black Soft Roll.5 W, 3 Spoke Alum. Rim, Smooth Polyurethane $230 Black Urethane.25 W, 3 Spoke Flat Free Smooth $65 Colored Casters W, 0 Spoke Acrylic, Smooth, Flat Free $85 Color: Orange Yellow Green Red Blue Clear 5 Casters 2 : Black Urethane.5 W, 3 Spoke Flat Free Smooth Black Soft Roll.5 W, 3 Spoke Alum. Rim, Smooth Polyurethane $230 Gray Flat Free Aluminum Wheel, Smooth Flat Free Tire $65 Extension: Set Length at 5 : Extension: Set Length at 5 : Extension: Set Length at 5 : Ultra Hemi: Ultra Hemi Aluminum Swing-Aways Leg Length Style: 60 o 70 o 2 FOOTPLATES See Chart On Page 5 For Footplate Compatibilty For Your Configuration Footplate, Comfort Adjustable Size: 4.25 W 4.25 W, Narrow 5 W 6 W Angle Adjustable Aluminum Footplates $85 K0040 Size: 5.5 W 6.5 W 7.5 W Accessories: Heel Loops $38 E095. Required on 4 W seat. Not available with HD package. SLING SEAT Adjustable Tension Sailcloth Set Length at 5 : High Pivot Elevating Legrests $295 E Leg Length Calf pad: Standard Offset Depth Adjustable Set Length at 5 : Only available on seats 6 W or greater. N/A in artic white. 2. Not available with 8 casters. 3. Can not be used with 5, 6, or 8 casters. 4. Not available on 4 W seat. Not available with HD package. Not available with occupied transit kit. 5. Measurement is taken from top of frame.. Not available with HD package casters can not be used with 90 degree legrests. Revised: August 25, 204 Page 4 of 6

5 SEAT CUSHIONS No Cushion Required Please refer to Synergy order forms for detailed pricing, sizes and codes. Simplicity Cushion General Use 6 x 6-20 x 20 $98 E x 6-22 x 20 $98 E2602 Solution Cushion Skin Protection 4 x 4-20 x 8 $380 E x x 20 $430 E x 6-22 x 20 $430 E2604 Solution Cushion Skin Protection & Positioning 0 x 0-20 x 8 $380 E x x 20 $430 E x 6-22 x 20 $430 E2608 Spectrum Gel Cushion Positioning 2 x 0-20 x 9 $480 E x x 20 $530 E x 6-22 x 20 $530 E2606 Spectrum Visco Cushion Skin Protection & Positioning 0 x 0-20 x 8 $480 E x x 20 $530 E x 6-22 x 20 $530 E2608 Spectrum Air Adjustable Skin Protection 4 x 2-20 x 20 $480 E x 6-22 x 20 $530 E2623 Spectrum Air Contour Adjustable Skin Protection & Positioning 4 x 2-20 x 20 $499 E x 6-22 x 20 $549 E2625 FOOTPLATE COMPATABILITY CHART Chair Width 4" 5" 6" 7" 8" 9" 20" 2" 22" (HD Only) Legrest 4.25" W (Narrow) & 5.5" W Aluminum 4.25" W Maximum Footplate Size Is Measured To Provide 3/4 Minimum Between Footplates Chart Shows Maximum Extension Length For Given Footplate Size And Seat Width 5" W & 6.5" W Aluminum 6" W & 7.5" W Aluminum Straight 4.25" W Narrow N/A N/A N/A 70 Tapered N/A N/A N/A N/A Straight ALL ALL N/A N/A 70 Tapered N/A N/A N/A N/A Straight ALL ALL N/A N/A 70 Tapered 4" N/A N/A N/A Straight ALL ALL ALL N/A 70 Tapered 7.5 ext. 4.75" ext. N/A N/A Straight ALL ALL ALL N/A 70 Tapered ALL 9.75" ext. N/A N/A Straight ALL ALL ALL ALL 70 Tapered ALL ALL 6" ext. N/A Straight ALL ALL ALL ALL 70 Tapered ALL ALL ALL 4 Straight ALL ALL ALL ALL 70 Tapered ALL ALL ALL 6.75 ext. Straight N/A ALL ALL ALL 70 Tapered N/A ALL ALL ALL MAXIMUM LEG LENGTH CHARTS Front STF Maximum Leg Length is measured with 3/4 minimum ground clearance with footplates set at 90 o to legrest. Footplates Aluminum Footplates 2 Ultra Hemi Frame Rear Front Rear Maximum Legrest Length STF Degree Degree Degree Degree STF STF Degree Degree Degree Degree Angle Adjustable Front Rear Footplates Footplates 5 STF STF degree 70 degree 60 degree 70 degree N/A 2.5 N/A N/A N/A N/A N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A 4.75 N/A N/A N/A N/A N/A N/A 4.75 N/A N/A N/A N/A N/A N/A 4.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A. Leg Length measured from top of seat pan to footplate N/A N/A N/A N/A 2. Footplate in middle position N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Revised: August 25, 204 Page 5 of 6

6 ACCESSORIES NOTES: Adjustable Rear Anti-Tip Wheels $05 E097 Removable Plastic Side Guards, Small $90 Removable Aluminum Side Guards, Large $20 Lap Belt 2 $50 E0978 Spinergy Spoke Protectors 3 $90 Size: Gel Arm Covers For 2 Tubular Arms $99 Case Logic Under Seat Organizer $85 Touch-up Paint $25 7-Piece Tool Kit $25 Combat Cane/Crutch Holder $95 E2207 Backpack w/ Quantum Logo $60. Not available with camber. 2. Not available with occupied transit kit. 3. Not available with projection hand rims. TRANSIT SECUREMENT PACKAGE Occupied $35 with anti-tips $05 E097 without anti-tips Unoccupied $275 with anti-tips $05 E097 without anti-tips. Not available with HD or Ultra Hemi packages. THIS SECTION MUST BE READ The Transit Securement Package, when used in conjunction with a wheelchair was tested in the specific configuration of a 6 x6 seat size, with 5-9 straight back canes, desk-length height-adjustable armrests, padded back sling upholstery, and 70-degree bi-directional legrests, conforms with the standard of ANSI/RESNA WC/ Vol. 4, Section 9, for the purpose of enabling wheelchairs to be secured in certain types of motor vehicles. The Transit Securement Package, including manufacturer-installed front and rear securement brackets and pelvic belt anchoring brackets, has been crash tested in accordance with ANSI/RESNA WC/Vol. 4,Section 9,Frontal Impact Test, with a 68-lbs. (76.2 kg) surrogate occupant corresponding to a user weight range of 5 lbs. (52.6 kg) to 20 lbs. (95.25 kg). While the Transit Securement Package is compatible with additional seat sizes, optional components, and varied configurations, and provides designated securement points, Pride Mobility makes no claims that any other components or configurations have been tested beyond the above described ANSI/RESNA conforming configuration. Please refer to the Transit Securement Package supplement (part number INFMANU3659) for additional information. However, the transit kit can be purchased with any size chair. Revised: August 25, 204 Page 6 of 6