q Little Wave Flip XP-Rigid Base E1233, E1161 $

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Funder: Therapist: Date: q MOH q ACC Marked For: Details: Ship To: Address: City: Postcode: Phone: Email: Notes: q Little Wave Flip XP-Rigid Base E1233, E1161 $ 74 kg weight capacity. Price includes one time free growth kit. Tilt range: 0º - 45º. q Little Wave Flip XP-Folding Base E1234, E1161 $ 74 kg weight capacity. Price includes one time free growth kit. Tilt range: 0º - 45º. Frame Frame Width Select box corresponding to desired Frame Width Frame Width q 10 q 11 q 12 q 13 q 14 q 15 q 16 q 17 q 18 Select in desired Range Range Short 12-16 q 12 q 13 q 14 q 15 q 16 Medium 14-18 q 14 q 15 q 16 q 17 q 18 Effective 01/10/2018 Transit Option q Transit System K0108 N/C Offset Hanger Option q Offset Hanger $ Available only Rigid Base. Not available 12. Tilt Mechanism q Hand N/C q Foot N/C Long 16-20 q 16 q 17 q 18 q 19 q 20 $ Backrest Back Post / Height Range / Back Height Select Back Height in row corresponding to desired Back Post and Height Range Back Post Price Height Range Stroller Handle Back Post (Folding) N/C Short q 20 Tall q 24 Back Height Fixed Height Adjustable Handle 1 (Folding) N/C Short q 22 Tall q 26 Adjustable Height Adjustable Handle (Folding) 1 Not available Seating Dynamics Rocker Back $ Short 1 q 18 q 19 q 20 q 21 q 22 q 23 q 24 q 25 Tall q 20 1 q 21 1 q 22 1 q 23 q 24 q 25 q 26 q 27

Backrest continued Stroller Handle Back Post Option Available only Stroller Handle Back Post q Removable Stroller Handle Extension $ Footrest Hanger / Front Frame Bend q 60º N/C Available only Extension Tube Hangers q 70º N/C q 80º N/C Not available 8 Casters q 90º N/C Available only Front Mount Hangers. Not available 8 Casters. q Pro Elevating Leg Rests (PRO ELR) E0990 $ Not available Frame Widths less than 14 out Offset Hangers or Frame Widths less than 12 Offset Hangers q Omit Hangers - $ Other Backrest Options q Non Folding Back N/C Standard Seating Dynamics Rocker Back q Seating Dynamics Rocker Back K0108 $ Not available Flip Up Armrests. Available only Non Folding Back. q Adjustable Height Rigidizer Bar $ Footplate q Composite N/C Not available Front Mount Hangers, Frame Widths less than 14 out Offset Hangers, Frame Widths less than 12 Offset Hangers or PRO ELR q Composite Angle Adjustable K0040 $ Not available Front Mount Hangers or 10-12 Frame Widths. 13 and 14 Frame Widths require Offset Hangers. q Aluminum Angle Adjustable K0040 $ q One Piece Flip Up Angle Adjustable K0040 $ Not available Front Mount Hangers, PRO ELR, Frame Widths less than 14 out Offset Hangers or Frame Widths less than 12 Offset Hangers Footrest / Extension / Seat to Footrest Length Select Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5 shorter than Front Seat Height recommended. Extension Tube Hanger measurements based on 70º Hanger Bend. Footrest Extension Seat to Footrest Length Extension Tube Hangers (60º, 70º, 80º) Short q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 Medium q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 Long q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 Front Mount Hangers 1 Short (70º, 80º, 90º) Medium (70º, 80º, 90º) Long (70º, 80º) Standard Selections Requires 3 Extension for $ q 5 q 5.5 q 6 q 6.5 q 8.5 q 9 q 9.5 q 7 q 7.5 q 8 q 10 q 10.5 q 11 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 10.5 q 11 q 11.5 q 8 q 8.5 q 9 q 9.5 q 10 q 12 q 12.5 q 13 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 12.5 q 13 q 13.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 14 q 14.5 q 15 PRO ELR Low Pivot Short q 10.5-15.5 Long q 13-19 PRO ELR High Pivot Short q 8.5-17 Long q 11.5-17.5 1 Available only Aluminum Angle Adjustable Footplates. See Minimum Front Seat Height chart below. Minimum Front Seat Height Front Mount Hangers Hanger Length Short Medium Long Hanger Bend 70º 80/90º 70º 80/90º 70º 80º Minimum Front Seat Height Standard Selection Minimum Front Seat Height 3 Extension 13 13 13 13.5 14.5 15.5 13.5 14 15.5 16 17 18 3 Extension Available only Front Mount Hangers. Provided as parts. q 3 Extension for Front Mount Hanger $

Footrest continued Heel Loop q Heel Loops E0951 $ Not available One Piece Flip Up Angle Adjustable Footplates, Frame Widths less than 14 out Offset Hangers or Frame Widths less than 12 Offset Hangers q Adjustable Heel Loops E0951 New! $ Not available One Piece Flip Up Angle Adjustable Footplate, Frame Widths less than 14 out Offset Hangers or Frame Widths less than 12 Offset Hangers q Omit Heel Loops N/C Calf Strap q Velcro Adjustable K0038 $ q Padded Velcro Adjustable K0038 $ q Bodypoint Padded AeroMesh K0038 $ Residual Limb Support Residual Limb Support E1020 q Left $ q Right $ q Omit Left Hanger - $ q Omit Right Hanger - $ Cover q Smooth q Air Mesh q Smooth q Air Mesh Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14 Hanger Release If no selection is made 4-Way - In line will be used hangers or Classic will be used PRO ELR q Classic Std q 4-Way - In line N/C See reference A to the right. Allows chair to be folded out removing footrest hanger. Not available PRO ELR. q 4-Way - Out N/C See reference B to the right A B

Seat Height, Casters and Rear Wheels Seat Height / Caster Size / Rear Wheel Size Select Seat Height corresponding to desired Rear Wheel and Caster Size Rear Wheel Size 12 Pneumatic or Pneumatic Airless Insert 12 Full Poly 16 Pneumatic, Pneumatic Airless Insert or Full Poly 16 Low Poly Caster Size 5 6 6 x 2 7 8 8 x 2 Seat Height q 13.5 q 14 q 14 4 q 14 4 q 14.5 q 14.5 q 14.5 q 15 q 15 q 15 q 15 4 q 16 q 16 q 16 q 16 q 17 q 17 q 17 q 17 3 q 17 3 q 17 3 q 13.5 q 14 q 14.5 q 14.5 q 14.5 q 15 q 15 q 15 q 16 q 16 q 16 q 16 q 16 4 q 16 4 q 17 q 17 q 17 q 17 3 q 17 3 q 17 3 q 15 q 15 q 15 q 15 4 q 16 q 16 q 16 q 16 q 16 4 q 18.5 4 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19.5 2 q 19.5 4 q 19.5 4 q 19.5 3 q 14 q 14 4 q 14 4 q 14.5 q 14.5 q 14.5 q 15 q 15 q 15 q 16 q 16 q 16 q 16 q 16 4 1 Self Propel Axle Plate selections limit tilt range 2 Not available 12 3 Not available 12-16 4 Not available 17-20 5 Not available in combination Spoke wheels and Full Poly Rear Type 6 Not available in combination Spoke wheels, Full Poly Rear Type and 17-20 7 Not available in combination Mag wheels and 17-20 8 Not available in combination Spoke wheels, Pneumatic tires and 17-20 9 17-20 requires Spoke wheels and Full Poly Rear Type Rear Wheel Size 16 Drum Brake 20 20 1 Self Propel 22 1 Self Propel 24 1 Self Propel Caster Size 5 6 6 x 2 7 8 8 x 2 Seat Height q 15 q 15 q 15 q 16 q 16 q 16 q 16 q 16 q 16 3 q 18.5 4 q 18.5 q 18.5 4 q 18.5 4 q 18.5 q 18.5 3 3 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 20 q 20 4 q 20 4 q 20 q 20 q 20 q 16 q 16 q 16 q 16 q 16 q 16 q 18.5 4 q 18.5 q 18.5 q 18.5 4 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19.5 4 q 19.5 2 q 19.5 4 q 19.5 4 q 19.5 3 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19.5 7,8 q 19.5 q 19.5 q 19.5 9 q 19.5 7,8 q 19.5 q 20 5 q 20 6 q 20 6 q 20 q 20 q 20

Seat Height, Casters and Rear Wheels continued Caster Type q.75 Lighted Rollerblade $ Not available 6", 7 and 8" Caster Sizes q 1 Poly N/C q 1 Poly Aluminum $ Not available 6, 7 and 8 Caster Sizes q 1 Pneumatic $ Not available 5 and 7 Caster Sizes q 1.5 Poly $ Not available 7 and 8 Caster Sizes q 1.5 Soft Roll Aluminum $ Not available 7 and 8 Caster Sizes q 2 Poly $ Not available 5, 7 and 8 Caster Sizes q 2 Pneumatic w/ Foam Insert E2217 $ Not available 5, 6 and 7 Caster Sizes Axle No selection needed Drum Brake q Fixed N/C Not available Folding Base Frame and Standard Wheel Locks q Quick Release N/C Rear Wheel Type q Mag (Black) N/C q Colored Mag $ Available only in 20 and 22 rear wheels Color: q Florescent Red q White q Blue q Pink q Spoke $ Not available in 12 or 16 rear wheels Wheel Locks Wheel Lock q Push to Lock N/C Rear wheels must be removed to fold chair this wheel lock selection. q Pull to Lock N/C Not available 12 or 16 Full Poly tires. Rear wheels must be removed to fold chair this wheel lock selection. q Attendant Foot Lock N/C Available only 12 and 16 Mag wheels. q Drum Brake E2228 $ Not available Hand Tilt Mechanism or 16 Low Poly tire. Available only 16 rear wheel. Axle is Quick Release. q Omit Wheel Locks N/C Rear Type q Full Poly E2218 N/C q Low Poly E2218 N/C Available only 16 rear wheel q Pneumatic E2211, E2212 $ q Pneumatic Airless Insert E2211, E2213 $ Handrim Handrims not available on 12 or 16 rear wheels Standard Handrims q Aluminum Anodized Std q Plastic Coated $ q Projection (8 Vertical Projections) $ Available on 24 rear wheel q Omit Handrims N/C Natural Fit Handrims Not available on 20 rear wheel or 22 Mag wheels. Not recommended Mag wheels. q Natural Fit LT Regular Grip $ q Natural Fit Standard Regular Grip $ q Natural Fit LT Super Grip $ q Natural Fit Standard Super Grip $ q Natural Fit LT Omit Grip $ q Natural Fit Standard Omit Grip $ Handrim Option Not available on Plastic Coated or Projection Handrims q 3M Micro Grip $ Wheel Lock continued Dual - Attendant Foot Lock $ Available only 12 and 16 Mag wheels. Rear wheels must be removed to fold chair this wheel lock selection. q Push to Lock q Pull to Lock Dual - Drum Brake $ Not available Hand Tilt Mechanism or 16 Low Poly tire. Available only 16 rear wheel. Axle is Quick Release. Rear wheels must be removed to fold chair this wheel lock selection. q Push to Lock q Pull to Lock Wheel Lock Options q Extension Handles E0961 $ Available only Push to Lock or Pull to Lock Wheel Locks.

Armrests Armrests Please select Arm Pad option q Height Adjustable Pediatric Desk (6.5-9 ) E0973 $ Best fit s less than 14 q Height Adjustable Pediatric Desk Tall (8-10.5 ) E0973 $ Best fit s less than 14 q Height Adjustable T-Arm (9.25-14.25 ) E0973 $ Not available 12 q Height Adjustable T-Arm Low (7.5-11.5 ) E0973 $ Not available 12 q Angle Adj. Locking Extendable Flip Up (9.5-15 ) E0973 $ Not available Seating Dynamics Rocker Back Accessories Removable Side Guard Not available Height Adjustable Armrests q Adult Composite Side Guards (14-16 ) K0108 $ q Pediatric Composite Side Guards (10-14 ) K0108 $ Positioning Belt q 1 Auto Buckle E0978 $ q 1 Padded Auto Buckle E0978 $ q 1 1/2 Auto Buckle E0978 $ q 1 1/2 Padded Auto Buckle E0978 $ q 2 Airline Buckle E0978 $ Belt Mounting Kit q Bodypoint 1 Band Clamp Belt Mounting Kit $ q Seat Belt Mounting Hardware $ Anti-Tip q Rear Anti-Tips E0971 $ Color Arm Pad Arm Pads not available Tubular Flip Up Armrest. Full Arm Pad not available Height Adjustable Pediatric Desk Armrests. Standard Arm Pad N/C q Desk q Full Waterfall Arm Pad $ q Desk q Full Not available Angle Adjustable Locking Flip Up Extendable armrests Foam Grip N/C q Desk q Full Available only Angle Adjustable Locking Extendable Flip Up Armrest Armrests Continued q Tubular Flip Up N/C Not available Seating Dynamics Rocker Back q Omit Armrests N/C Seat Pan q Growing Solid Seat Pan E2231 $ Spoke Guards q Clear Spoke Guards K0065 $ Not available Mag wheels q Black Spoke Guards K0065 $ Available only 22 and 24 Spoke wheels Designer Spoke Guards K0065 $ Available only 20 and 22 Spoke wheels Design: q Blue Monster q Fairy Garden q Havin a Hoot q Robo Fun q Rockin Reptiles q Super Puppies q Tutu Cute q Tuxedo Time Other Accessories q Tool Kit $ q Removable Underseat Pouch $ q Pediatric Ki Mobility Backpack $ q Ki Mobility Backpack $ q Black Neoprene Impact Guards $ q Tilt Stop Posterior (Pair) K0108 $ q Tilt Stop Anterior (Pair) K0108 $ Available only Rigid Base Frame and Accent Select desired frame and accent colors. Accent color is used on side panel; if no accent color is selected, frame color will be used. Gloss Finish Frame Accent Matte Finish Frame Accent Black N/C q q Army Green N/C q q Blue Skies N/C q q Charcoal Gray N/C q q Bubblegum Pink N/C q q Emerald Green N/C q q Candy Blue N/C q q Iridescent Burgundy N/C q q Candy Purple N/C q q Iridescent Navy N/C q q Candy Red N/C q q Retro Red N/C q q Copper N/C q q Royal Blue N/C q q Fuchsia N/C q q Shadow Black N/C q q Granny Smith N/C q q Smooth White N/C q q Metallic Orange New! N/C q q Silver N/C q q Teal N/C Yellow N/C q q q q

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