list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal code: City: Country: Phone: e-mail: Client Measurements Weight: Height: 1) Upper leg length: 2) Chest Depth: 3) Seat pan to elbow: 4) Arm pit height: 5) Top of shoulders: 6) Top of head: 7) Elbow to Hand: 8) Chest width: 9) Knee to Foot: 10) Hip width: kg All specifications and prices are subject to change without notice. Please note that displayed prices are only valid if ordered with the wheelchair. Any parts ordered for service or future alterations will carry different prices and warranty. Rabobank Parkstad Limburg Rekening: 1238.24.184 IBAN: NL84RABO0123824184 BIC/SWIFT: RABONL2U europe@permobil.nl Permobil Europe B.V. De Doom 22 NL 6419 CX HEERLEN Phone: +31 (0)45 564 54 90 Fax: +31 (0)45 564 54 91 Page 1 of 5
Chassis Model 105729-99-0 C300 VR2 ADV WITH TS-SEAT EUR 4,917.00 105733-99-0 C300 VR2 BASIC WITH TS-SE AT EUR 4,522.00 Colour covers 105703-99-0 COVER BLACK ONYX C300 EUR - 105701-99-0 COVER COBALT BLUE C300 EUR - 105702-99-0 COVER DEEP PURPLE C300 EUR - 105704-99-0 COVER PHANTOM GRAY C300 EUR - 105705-99-0 COVER POPSTAR PINK C300 EUR - 105706-99-0 COVER VOLCANO RED C300 EUR - Cover inserts 105829-99-0 LID KIT COVER C300 EUR - Hub cap 105719-99-0 HUB CAP BLACK ONYX INCL R EFLECTOR EUR - 105708-99-0 HUB CAP COBALT BLUE INCL REFLECTOR EUR - 105710-99-0 HUB CAP DEEP PURPLE INCL REFLECTOR EUR - 105712-99-0 HUB CAP PHANTOM GRAY INCL REFLECTOR EUR - 105721-99-0 HUB CAP POPSTAR PINK INCL REFLECTOR EUR - 105714-99-0 HUB CAP VOLCANO RED INCL REFLECTOR EUR - Front wheels 103498-99-0 WHEELS 3.00x8" AIR FILLED TIRES EUR - 103499-99-0 WHEELS 3.00x8" SOLID TIRES EUR 138.00 104871-99-0 WHEEL 3.00-8" MUD/SNOW AIR TIRE (1 pair) EUR 138.00 Accessoires chassis Batteries 101969-99-0 BATTERIES, 60Ah, SET OF 2 EUR - 100661-99-0 WITHOUT BATTERIES EUR - Charger 104877-99-0 CHARGER PERMOBIL 24V/8A EU EUR - 100662-99-0 WITHOUT CHARGER EUR - Light kit 105802-99-0 LIGHT KIT WITH FRONT INDI CATOR C300/K300 VR2 EUR 369.00 105717-99-0 REFLECTOR KIT C300/K300 EUR - Chassis adaption for Permolock C3 (+) 104626-99-0 ADAPT C300/350 FOR PERMOLOCK C3 EUR 102.00 Rain cover (+) 101888-99-0 TARPAULIN/RAINCOVER FOR ALL MODLES EUR 113.00 Seat assembly Seat lift system 106747-99-0 SEAT ELEVATOR C300 VR2 EUR 1,103.00 106750-99-0 SEAT ELEVATOR FOR SEAT TI LT C300 VR2 EUR 1,103.00 104634-99-0 SEAT TUBE FIXED TS C300/C350 EUR - Seat tilt options 104419-99-0 POWERED ADJ.SEAT TILT 30 TS EUR 1,273.00 104360-99-0 FIXED SEAT ANGEL TS EUR - Seat Seat 105677-99-0 SEAT TS C300 C350 EUR - Seat depth (+) 105627-99-0 MOUNTING POSITION SEAT DEPTH 360mm TS EUR - 105628-99-0 MOUNTING POSITION SEAT DEPTH 410mm TS EUR - 105629-99-0 MOUNTING POSITION SEAT DEPTH 460mm TS EUR - 105630-99-0 MOUNTING POSITION SEAT DEPTH 510mm TS EUR - Page 2 of 5
Seat depth (+) 105631-99-0 MOUNTING POSITION SEAT DEPTH 560mm TS EUR - Seat width (+) 105632-99-0 MOUNTING POSITION SEAT WIDTH 380mm TS EUR - 105633-99-0 MOUNTING POSITION SEAT WIDTH 430mm TS EUR - 105634-99-0 MOUNTING POSITION SEAT WIDTH 480mm TS EUR - 105635-99-0 MOUNTING POSITION SEAT WIDTH 530mm TS EUR - Seat options 104736-99-0 SOLID SEAT PLATE WITHOUT CUSHION EUR 204.00 104364-99-0 SEAT "SLING SEAT" 380-430 INCL. CUSHION EUR - 104365-99-0 SEAT "SLING SEAT" 480-530 INCL. CUSHION EUR - Backrest 104350-99-0 BACKREST SLING BACK LONG 380x430 INCL. CUSHION EUR 91.00 104351-99-0 BACKREST SLING BACK LONG 480x530 INCL. CUSHION EUR 91.00 104352-99-0 BACKREST SLING BACK SHORT 430x450 INCL. CUSHION EUR - 104353-99-0 BACKREST SLING BACK SHORT 480-530 INCL. CUSHION EUR - 100655-99-0 BACKREST WITHOUT SLING BACK EUR - Strap extensions (+) 105660-99-0 STRAP EXTENSION LONG BACK REST TS EUR - 105661-99-0 STRAP EXTENSION SHORT BACKREST TS EUR - Adjustment backrest 105626-99-0 MANUAL CONTROL BACKREST TS EUR - 105646-99-0 POWER CONTROL BACKREST C300/C350 TS EUR 994.00 Legrest 104356-99-0 LEGREST CENTER MOUNTED MANUAL ADJUSTABLE EUR - 104357-99-0 LEGREST CENTER MOUNTED POWERED ADJUSTABLE EUR 1,103.00 104346-99-0 LEGRESTS SWING AWAY TS EUR - Armrest leveling support / reinforcement (+) 104348-99-0 ARMRESTS PARELLEL MOVING EUR 121.00 Accessories seat Headrest (+) 104361-99-0 HEAD SUPPORT "ERGO" (REQUIRES PUSH HANDLES) EUR 228.00 Backrest extension (+) 104349-99-0 BACKREST EXTENSION KIT TS EUR 95.00 Lateral support (+) 103050-99-0 LATERAL SUPPORTS SMALL(A) 150x140 TEXTILE (MESH) EUR 274.00 103062-99-0 LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR 286.00 103056-99-0 LATERAL SUPPORTS MED(F) 220x90 TEXTILE (MESH) EUR 280.00 Thigh support (+) 103095-99-0 THIGH SUPPORTS TEXTILE (MESH) 200x90 LARGE (C) EUR 358.00 103094-99-0 THIGH SUPPORTS TEXTILE (MESH) 165x120 MEDIUM (J) EUR 352.00 103092-99-0 THIGH SUPPORTS TEXTILE (MESH) 110x90 SMALL (B) EUR 345.00 102977-99-0 THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR 363.00 Calf support (+) 102982-99-0 CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR 238.00 Seatbelt (+) 104514-99-0 BELT 2-POINT LARGE NONPAD BODYPOINT INCL BRACK UT EUR 104.00 104516-99-0 BELT 2-POINT LARGE PADDED BODYPOINT INCL BRACK UT EUR 149.00 104518-99-0 BELT 2-POINT MEDIUM NONPA D BODYPOINT INCL BRACK UT EUR 97.00 104520-99-0 BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR 141.00 100600-99-0 SAFETY BELT,AUTOTENSION LONG VERSION EUR 124.00 100518-99-0 SAFETY BELT,BUCKLE EUR 51.00 100519-99-0 SAFETY BELT,AUTOTENSION EUR 124.00 Mounting position seatbelt (+) 105010-99-0 MOUNT POS SEATBELT ROLL RIGHT EUR - 105011-99-0 MOUNT POS SEATBELT ROLL LEFT EUR - Push handles back (+) 104362-99-0 PUSH HANDLES TS EUR 191.00 Page 3 of 5
Stump support (+) 103070-99-0 STUMP SUPPORT LARGE (H) 170x175 TEXTILE (MESH) EUR 148.00 103068-99-0 STUMP SUPPORT MEDIUM (J) 165x120 TEXTILE (MESH) EUR 143.00 103067-99-0 STUMP SUPPORT SMALL (A) 150x140 TEXTILE (MESH) EUR 138.00 103071-99-0 STUMP SUPPORT XLARGE (D) 200x200 TEXTILE (MESH) EUR 154.00 Support handles set (+) 105260-99-0 SUPPORT HANDLES SET (pair) C 3G EUR 148.00 Support handle armrest (+) 105655-99-0 SUPPORT HANDLE ARMREST TS JR EUR 120.00 Table adjust angel (+) 103426-99-0 TABLE,ANGLE ADJUST. 1-SIDE FIXATION EUR 447.00 Table small for armrest mount (+) 105656-99-0 TABLE SMALL ARMREST MOUNT -ED TS JR EUR 240.00 Crutch holder (+) 104827-99-0 CRUTCH HOLDER TS EUR 122.00 Holder oxygen bottle (+) 104831-99-0 HOLDER OXYGEN BOTTLE TS EUR 223.00 User control User control 103612-99-0 JOYSTICK VR2 BASIC WIHOUT SEAT/LIGHT BUTTONS EUR - 103613-99-0 JOYSTICK VR2 ADVANCED WITH SEAT/LIGHT BUTTONS EUR - Joystick holder 103473-99-0 PANELHOLDER VR2/R-NET STD L=335 EUR - 103474-99-0 PANELHOLDER VR2/R-NET L=435 EUR - 104948-99-0 PANEL HOLDER CENTRAL STEE RING EUR 230.00 104302-99-0 PANELHOLDER PAR. SW. AWAY VR2/R-NET L/R EUR - 102835-99-0 WITHOUT PANELHOLDER EUR - Mounting position joystick (+) 105032-99-0 MOUNT POS CONTROLBOX LEFT EUR - 105031-99-0 MOUNT POS CONTROLBOX RIGHT EUR - Attendant control Attendant control (+) 104223-99-0 JOYSTICK ATTENDANT VR2 EUR 931.00 Permolock Permolock C3 (+) 104022-99-0 PERMOLOCK C3 WITH STANDARD SWITCH EUR 904.00 User manual Permolock (+) 104713-99-0 USER MANUAL DK PERMOLOCK C3 EUR - 104720-99-0 USER MANUAL EU PERMOLOCK C3 EUR - 104716-99-0 USER MANUAL FI PERMOLOCK C3 EUR - 104717-99-0 USER MANUAL FR PERMOLOCK C3 EUR - 104718-99-0 USER MANUAL DE PERMOLOCK C3 EUR - 104714-99-0 USER MANUAL NL PERMOLOCK C3 EUR - 104719-99-0 USER MANUAL IT PERMOLOCK C3 EUR - 104711-99-0 USER MANUAL NO PERMOLOCK C3 EUR - 104721-99-0 USER MANUAL PT PERMOLOCK C3 EUR - 104722-99-0 USER MANUAL ES PERMOLOCK C3 EUR - 104712-99-0 USER MANUAL SE PERMOLOCK C3 EUR - 104715-99-0 USER MANUAL US PERMOLOCK C3 EUR - Release lever (+) 102841-99-0 MANUAL RELEASE FOR PERMOLOCK C EUR 179.00 Quicklock holder release lever (+) 102859-99-0 QUICKLOCK HOLDER RELEASE LEVER EUR 57.00 Spacer kit (+) Page 4 of 5
Spacer kit (+) 102864-99-0 SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) 101411-99-0 PERMOLOCK SNAP IN KIT EUR 152.00 Car Seat adapter (+) 104708-99-0 CAR SEAT ADAPTER PERMOLOCK C3 EUR 339.00 Wheel spacer (+) 104707-99-0 WHEEL BUMP FOR PERMOLOCK C3 EUR 29.00 Extension cable Permolock (+) 104232-99-0 EXTENSION CABLE FOR PERMOLOCK C,C3 EUR 57.00 Chair Order Policy: For other options and special adaptations, please call Permobil for further details. Please also refer to Permobil s Delivery Policy for further information. Your order cannot be processed without the following: - The client s name - The client s measurements - The client s weight For your ordering, please sign below with date and company stamp. Signature: Date: Company Stamp: An order confirmations will be provided by Permobil summarizing the items selected. Please review this carefully. Page 5 of 5