C350 Corpus VR2 Advanced

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 8

Chassis Model 103630-99-0 C350 CORPUS VR2 ADVANCED EUR 5,653.00 User manual 103760-99-0 USER MANUAL ES C350 EUR - User manual seat 104727-99-0 USER MANUAL ES CORPUS SEAT EUR - Colour covers 103529-99-0 COVERS C350 BLACK EUR - 103533-99-0 COVERS C350 DARK BLUE METALLIC EUR - 103532-99-0 COVERS C350 RED EUR - 103530-99-0 COVERS C350 SILVER METALLIC EUR - 103531-99-0 COVERS C350 YELLOW EUR - Hub cap 103540-99-0 HUB CAP INCL. REFLECTOR BLACK EUR - 103539-99-0 HUB CAP INCL. REFLECTOR DARK BLUE METALLIC EUR - 103510-99-0 HUB CAP INCL. REFLECTOR RED METALLIC EUR - 103541-99-0 HUB CAP INCL. REFLECTOR SILVER METALLIC EUR - 103542-99-0 HUB CAP INCL. REFLECTOR YELLOW EUR - Front wheels 103557-99-0 WHEELS 2.5-3" SOLID TIRES EUR - Rear 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 Drive parameters 103660-99-0 PROGR.SET: C350 VR2/70A ADVANCED 8 KMH EUR - Accessories chassis Batteries 101969-99-0 BATTERIES, 60Ah, SET OF 2 EUR - Charger 104877-99-0 CHARGER PERMOBIL 24V/8A EU EUR - Light kit (+) 103500-99-0 LIGHT KIT C350/VR2 EUR 369.00 _Curb Climber (+) 105443-99-0 CURB CLIMBERS KIT C 350 EUR 404.00 Chassis adaption for Permolock C3 (+) 104626-99-0 ADAPT C300/350 FOR PERMOLOCK C3 EUR 102.00 Reinforcement chassis for Permolock (+) 104637-99-0 REINFORCEMENT C350 CHASSIS FOR PERMOLOCK C3 EUR - Rain cover (+) 101888-99-0 TARPAULIN/RAINCOVER FOR ALL MODLES EUR 113.00 Seat assembly Seat lift system 103888-99-0 POWERED SEAT LIFT 200MM C350 / VR2 EUR 1,103.00 103815-99-0 POWERED SEAT LIFT 200MM C350 (COMB. WITH TILT) EUR 1,103.00 101994-99-0 SEAT TUBE FIXED C300/C350 EUR - 101995-99-0 SEAT TUBE FIXED C/K300 C350 (COMB. WITH TILT) EUR - Seat tilt options 100565-99-0 FIXED SEAT ANGLE 3 CII EUR - 103973-99-0 POWERED ADJ.SEAT TILT 30 VR2 EUR 1,273.00 101988-99-0 POWERED ADJ.SEAT TILT 45 C300/VR2 EUR 1,273.00 Seat Page 2 of 8

Seat 103478-99-0 SEAT 430x410 (FOR BACKR. ADJ. 90-150 ) EUR - 103479-99-0 SEAT 430x460 (FOR BACKR. ADJ. 90-150 ) EUR - 103480-99-0 SEAT 430x510 (FOR BACKR. ADJ. 90-150 ) EUR - 103481-99-0 SEAT 430x560 (FOR BACKR. ADJ. 90-150 ) EUR - 103482-99-0 SEAT 480x460 (FOR BACKR. ADJ. 90-150 ) EUR - 103483-99-0 SEAT 480x510 (FOR BACKR. ADJ. 90-150 ) EUR - 103484-99-0 SEAT 480x560 (FOR BACKR. ADJ. 90-150 ) EUR - Seat cushion 103293-99-0 SEAT CUSHION 420x370 TEXTILE (MESH) EUR - 103294-99-0 SEAT CUSHION 450x420 TEXTILE (MESH) EUR - 103296-99-0 SEAT CUSHION 450x500 TEXTILE (MESH) EUR - 103297-99-0 SEAT CUSHION 450x560 TEXTILE (MESH) EUR - 103299-99-0 SEAT CUSHION 500x500 TEXTILE (MESH) EUR - 103300-99-0 SEAT CUSHION 500x560 TEXTILE (MESH) EUR - 103387-99-0 SEAT CUSHION 420x370 VINYL EUR - 103388-99-0 SEAT CUSHION 450x420 VINYL EUR - 103389-99-0 SEAT CUSHION 450x500 VINYL EUR - 103390-99-0 SEAT CUSHION 450x560 VINYL EUR - 103391-99-0 SEAT CUSHION 500x500 VINYL EUR - 103392-99-0 SEAT CUSHION 500x560 VINYL EUR - 103292-99-0 WITHOUT SEAT CUSHION EUR -138.00 Backrest 101010-99-0 BACKR. 340x535 EUR - 100737-99-0 BACKR. 340x605 EUR - 101011-99-0 BACKR. 390x535 EUR - 100738-99-0 BACKR. 390x605 EUR - 101012-99-0 BACKR. 440x535 EUR - 100739-99-0 BACKR. 440x605 EUR - 100740-99-0 BACKR. 340 WIDE WITHOUT PLATE EUR -174.00 100741-99-0 BACKR. 390 WIDE WITHOUT PLATE EUR -174.00 100742-99-0 BACKR. 440 WIDE WITHOUT PLATE EUR -174.00 101962-99-0 BACK BIO-MECH. 390x605 EUR 311.00 101963-99-0 BACK BIO-MECH. 440x605 EUR 311.00 Backrest cushion 103310-99-0 BACKREST CUSHION 340x535 TEXTILE (MESH) EUR - 103311-99-0 BACKREST CUSHION 340x605 TEXTILE (MESH) EUR - 103312-99-0 BACKREST CUSHION 390x535 TEXTILE (MESH) EUR - 103313-99-0 BACKREST CUSHION 390x605 TEXTILE (MESH) EUR - 103314-99-0 BACKREST CUSHION 440x535 TEXTILE (MESH) EUR - 103315-99-0 BACKREST CUSHION 440x605 TEXTILE (MESH) EUR - 103322-99-0 BACKREST CUSHION 340x535 VINYL EUR - 103323-99-0 BACKREST CUSHION 340x605 VINYL EUR - 103324-99-0 BACKREST CUSHION 390x535 VINYL EUR - 103325-99-0 BACKREST CUSHION 390x605 VINYL EUR - 103326-99-0 BACKREST CUSHION 440x535 VINYL EUR - 103327-99-0 BACKREST CUSHION 440x605 VINYL EUR - 103309-99-0 WITHOUT BACKREST CUSHION EUR -172.00 Cover backrest (+) 104826-99-0 COVERS / WITHOUT BACKREST EUR - Adjustment backrest 103698-99-0 POWERED ADJ. BACKREST CORPUS C300-C350 EUR 994.00 103527-99-0 MANUAL ADJUST. BACKREST CORPUS/C300-C350 EUR - Legrest 104086-99-0 LEGREST 1-P FOOTPLATE EUR - 101966-99-0 LEGREST 2-P FOOTPLATES 20CM EUR - 104085-99-0 LEGREST 2-P FOOTPLATES 16CM AND COVER EUR - 104640-99-0 WITHOUT LEGREST CII EUR -454.00 Adjustment legrest 102206-99-0 MANUAL ADJUSTMENT LEGREST C300/C EUR - 102207-99-0 POWERED ADJ. LEGREST C300/C EUR 1,103.00 Page 3 of 8

Adjustment legrest 103997-99-0 WITHOUT LEGREST ADJUSTMENT EUR - Armrest Right 103331-99-0 ARMREST 250MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103339-99-0 ARMREST 250MM,RIGHT VINYL (PU FOAM) EUR - 103333-99-0 ARMREST 300MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103341-99-0 ARMREST 300MM,RIGHT VINYL (PU FOAM) EUR - 103335-99-0 ARMREST 350MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103343-99-0 ARMREST 350MM,RIGHT VINYL (PU FOAM) EUR - 103337-99-0 ARMREST 400MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103345-99-0 ARMREST 400MM,RIGHT VINYL (PU FOAM) EUR - 101351-99-0 WITHOUT ARMREST, RIGHT (BODY AND UPHOLSTERY) EUR -55.00 Armrest Left 103330-99-0 ARMREST 250MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103338-99-0 ARMREST 250MM,LEFT VINYL (PU FOAM) EUR - 103332-99-0 ARMREST 300MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103340-99-0 ARMREST 300MM,LEFT VINYL (PU FOAM) EUR - 103334-99-0 ARMREST 350MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103342-99-0 ARMREST 350MM,LEFT VINYL (PU FOAM) EUR - 103336-99-0 ARMREST 400MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103344-99-0 ARMREST 400MM,LEFT VINYL (PU FOAM) EUR - 101353-99-0 WITHOUT ARMREST, LEFT (BODY AND UPHOLSTERY) EUR -55.00 Armrest height adjustment 100523-99-0 ARMRESTS OVER 100MM HEIGHT ADJUSTMENT EUR 65.00 101744-99-0 ARMRESTS OVER 50MM HEIGHT ADJUSTMENT (STD) EUR - Armrests reinforcement (+) 101510-99-0 ARMREST REINFORCEMENT KIT HIGH EUR 121.00 Armrest configuration 101003-99-0 ARMRESTS HIGH MOUNTED EUR - 101002-99-0 ARMRESTS LOW MOUNTED EUR - Accessories seat Headrest (+) 103460-99-0 HEAD SUPPORT "ERGO" TEXTILE (BLACK TRIVERA) EUR 376.00 104130-99-0 HEAD SUPPORT, ADJUSTABLE TEXTILE (BLACK TRIVERA) EUR 226.00 104131-99-0 HEAD SUPPORT, ADJUSTABLE VINYL EUR 226.00 106291-99-0 STEALTH COMFORT PLUS 8" H EADREST PAD EUR 359.00 106259-99-0 STEALTH COMFORT PLUS MEDI UM 10" HEADREST PAD EUR 359.00 100712-99-0 WITHOUT HEADREST * EUR - Accessories rail headrest (+) 103697-99-0 ACCESSORIES RAIL HEAD SUPPORT EUR 45.00 _Mounting Kit Headrest STEALTH (+) 106301-99-0 STEALTH HEADREST HARDWARE - 1" BALL, SHORT 6" POST EUR 168.73 Lateral facial support left for Steath headrest (+) 106553-99-0 STEALTH 900 FACIAL LATERA L PAD - LEFT EUR 322.00 106552-99-0 STEALTH 910 FACIAL LATERA L PAD - LEFT EUR 322.00 106551-99-0 STEALTH 920 FACIAL LATERA L PAD - LEFT EUR 322.00 106314-99-0 STEALTH SWING AWAY EGG SW KIT FOR CMFRT PLUS HEADR EUR 398.00 _Lateral Pad Right STEALTH (+) 106284-99-0 STEALTH 900 FACIAL LATERA L PAD FOR COMFORT PLUS EUR 322.00 106286-99-0 STEALTH 910 FACIAL LATERA L PAD FOR COMFORT PLUS EUR 322.00 106288-99-0 STEALTH 920 FACIAL LATERA L PAD FOR COMFORT PLUS EUR 322.00 106554-99-0 STEALTH SWING AWAY EGG SW KIT HEADR - RIGHT EUR 398.00 Lateral support (+) 103050-99-0 LATERAL SUPPORTS SMALL(A) 150x140 TEXTILE (MESH) EUR 274.00 103056-99-0 LATERAL SUPPORTS MED(F) 220x90 TEXTILE (MESH) EUR 280.00 103062-99-0 LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR 286.00 Mounting set lateral support (+) 103425-99-0 MOUNTING KIT LATERAL SUPPORTS (BACKREST 340MM) EUR - Page 4 of 8

Thigh support (+) 103092-99-0 THIGH SUPPORTS TEXTILE (MESH) 110x90 SMALL (B) EUR 345.00 103094-99-0 THIGH SUPPORTS TEXTILE (MESH) 165x120 MEDIUM (J) EUR 352.00 103095-99-0 THIGH SUPPORTS TEXTILE (MESH) 200x90 LARGE (C) EUR 358.00 102977-99-0 THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR 363.00 Hip support (+) 103077-99-0 HIP SUPPORTS SMALL (B) 110x90 TEXTILE (MESH) EUR 345.00 103079-99-0 HIP SUPPORTS MEDIUM (A) 150x140 TEXTILE (MESH) EUR 352.00 103081-99-0 HIP SUPPORTS LARGE (C) 200x90 TEXTILE (MESH) EUR 358.00 103083-99-0 HIP SUPPORTS X LARGE (D) 200x200 TEXTILE (MESH) EUR 363.00 Calf support (+) 103053-99-0 CALF SUPPORTS LARGE (A)150x140 PU FOAM EUR 279.00 103055-99-0 CALF SUPPORTS SMALL (B)110x90 TEXTILE (MESH) EUR 213.00 102982-99-0 CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR 238.00 103058-99-0 CALF SUPPORTS LARGE (A)150x140 TEXTILE (MESH) EUR 279.00 102978-99-0 CALF SUPPORTS XLARGE (H)170x175 TEXTILE (MESH) EUR 266.00 103060-99-0 CALF SUPPORTS XXLARGE (D)200x200 TEXTILE (MESH) EUR 332.00 Chest strap (+) 105843-99-0 CHEST STRAP BODYPOINT ELA STIC LARGE EUR 86.00 105845-99-0 CHEST STRAP BODYPOINT ELA STIC SMALL EUR 72.00 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 106531-99-0 BELT, HIP 2-PT, PADDED XL PERMOBIL EU EUR 155.00 100600-99-0 SAFETY BELT,AUTOTENSION LONG VERSION EUR 124.00 100518-99-0 SAFETY BELT,BUCKLE EUR 51.00 100529-99-0 SAFETY BELT,4-POINT EUR 212.00 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 - Support handles set (+) 103651-99-0 TRANSFER HANDLES, SET (pair) UNI-TRACK EUR 148.00 Stump support (+) 103067-99-0 STUMP SUPPORT SMALL (A) 150x140 TEXTILE (MESH) EUR 138.00 103068-99-0 STUMP SUPPORT MEDIUM (J) 165x120 TEXTILE (MESH) EUR 143.00 103070-99-0 STUMP SUPPORT LARGE (H) 170x175 TEXTILE (MESH) EUR 148.00 103071-99-0 STUMP SUPPORT XLARGE (D) 200x200 TEXTILE (MESH) EUR 154.00 Mounting position stump support (+) 105009-99-0 MOUNT POS AMPUTATION SUPP -ORT LEFT EUR - 105008-99-0 MOUNT POS AMPUTATION SUPP -ORT RIGHT EUR - Accessories rail (+) 103176-99-0 ACCESSORIES RAIL EUR - 103177-99-0 ACCESSORIES RAIL +50 EUR - 103178-99-0 ACCESSORIES RAIL +100 EUR - 105675-99-0 UNITRACK BAR ACCESSORIE -100 EUR - 105676-99-0 UNITRACK BAR ACCESSORIE -50 EUR - 103468-99-0 WHITOUT ACCESSORIES RAIL EUR - Abduction wedge (+) 100978-99-0 ABDUCTION WEDGE, VINYL EUR 389.00 Support armrest inside Right (+) 101263-99-0 ARMREST SUPPORT,VINYL RIGHT INSIDE EUR 78.00 Support armrest inside Left (+) 101264-99-0 ARMREST SUPPORT,VINYL LEFT INSIDE EUR 78.00 Support armrest outside Right (+) 101261-99-0 ARMREST SUPPORT,VINYL RIGHT OUTSIDE EUR 78.00 Support armrest outside Left (+) 101262-99-0 ARMREST SUPPORT,VINYL LEFT OUTSIDE EUR 78.00 Page 5 of 8

Push handles back (+) 100975-99-0 PUSH HANDLES,MOUNTED ON THE BACKREST EUR 191.00 Support handle armrest (+) 103194-99-0 SUPPORT HANDLE ARMREST CORPUS EUR 120.00 Table Swing able (+) 103982-99-0 TABLE,SWING AWAY 600MM FOR JOYSTICK L/R EUR 475.00 103983-99-0 TABLE,SWING AWAY 650MM FOR JOYSTICK L/R EUR 475.00 Mounting position table (+) 105021-99-0 MOUNT POS TABLE SWINGABLE LEFT EUR - 105020-99-0 MOUNT POS TABLE SWINGABLE RIGHT EUR - Table adjust angel (+) 100576-99-0 TABLE,ANGLE ADJUST.390MM BACK WIDTH, REMOVABLE EUR 403.00 100577-99-0 TABLE,ANGLE ADJUST.440MM BACK WIDTH, REMOVABLE EUR 403.00 103426-99-0 TABLE,ANGLE ADJUST. 1-SIDE FIXATION EUR 447.00 Table small for armrest mount (+) 101691-99-0 COLLEGE TABLE,LEFT EUR 240.00 100578-99-0 COLLEGE TABLE RIGHT EUR 240.00 Incontinence protection (+) 102808-99-0 INCONTINENCE PROTECTION 430x360/430x410 EUR 48.00 102807-99-0 INCONTINENCE PROTECTION 430x460/430x510/430x560 EUR 51.00 102809-99-0 INCONTINENCE PROTECTION 480x410 EUR 51.00 102806-99-0 INCONTINENCE PROTECTION 480x460/480x510/480x560 EUR 58.00 Comfort seat cushion (+) 104739-99-0 SEAT CUSHION COMFORT 450x420,TEXTILE (MESH) EUR 299.00 104740-99-0 SEAT CUSHION COMFORT 450x450,TEXTILE (MESH) EUR 299.00 104741-99-0 SEAT CUSHION COMFORT 450x530,TEXTILE (MESH) EUR 299.00 104742-99-0 SEAT CUSHION COMFORT 450x560,TEXTILE (MESH) EUR 299.00 104744-99-0 SEAT CUSHION COMFORT 500x530,TEXTILE (MESH) EUR 299.00 104743-99-0 SEAT CUSHION COMFORT 500x500,TEXTILE (MESH) EUR 299.00 104745-99-0 SEAT CUSHION COMFORT 500x560,TEXTILE (MESH) EUR 299.00 104725-99-0 SEAT CUSHION COMFORT 450x500,TEXTILE (MESH) EUR 299.00 Comfort seat plate (+) 101227-99-0 SEAT PLATE COMFORT 430x460/510 EUR 154.00 Armrests sidewarts flip-up (+) 102322-99-0 ARMREST SIDEWARTS FLIP-UP EUR 373.00 Armrest pouch Right (+) 100671-99-0 ARMREST POUCH,RIGHT EUR - Armrest pouch Left (+) 100672-99-0 ARMREST POUCH,LEFT EUR - Seat frame pouch (+) 102588-99-0 SEATFRAME POUCH EUR 32.00 Bag hooks (+) 105805-99-0 BAG HOOKS OPEN EUR 34.00 Back pack (+) 102059-99-0 BACK PACK EUR 309.00 _Rear View Mirror Left (+) 105818-99-0 REAR VIEW MIRROR UNITRACK SEAT FRAME LEFT EUR 141.00 _Rear View Mirror Right (+) 105819-99-0 REAR VIEW MIRROR UNITRACK SEAT FRAME RIGHT EUR 141.00 Cup/Cellphone holder (+) 103044-99-0 CUP/PHONE HOLDER EUR 21.00 Foot straps (+) 103427-99-0 FOOTSTRAPS WITHOUT PADS EUR 30.00 103104-99-0 FOOTSTRAPS WITH PADS EUR 68.00 Lumbar support (+) 101972-99-0 LUMBAR SUPPORT,AIR EUR 155.00 Crutch holder (+) 101956-99-0 CRUTCH HOLDER EUR 122.00 Page 6 of 8

Holder oxygen bottle (+) 101964-99-0 HOLDER OXYGEN BOTTLE CORPUS EUR 223.00 User control User control 103613-99-0 JOYSTICK VR2 ADVANCED WITH SEAT/LIGHT BUTTONS EUR - Joystick holder (+) 104948-99-0 PANEL HOLDER CENTRAL STEE RING EUR 230.00 104302-99-0 PANELHOLDER PAR. SW. AWAY VR2/R-NET L/R EUR - Mounting position joystick (+) 105032-99-0 MOUNT POS CONTROLBOX LEFT EUR - 105031-99-0 MOUNT POS CONTROLBOX RIGHT EUR - Joystick knobs (+) 101165-99-0 JOYSTICK KNOB BALL SMALL EUR 13.00 105846-99-0 JOYSTICK HANDLE BODYPOINT 3" U-SHAPED EUR 48.00 105847-99-0 JOYSTICK HANDLE BODYPOINT 4" U-SHAPED EUR 51.00 105848-99-0 JOYSTICK HANDLE BODYPOINT RUBBER DOME EUR 46.00 100962-99-0 JOYSTICK KNOB BALL BIG EUR 16.00 100960-99-0 JOYSTICK KNOB CHIN CUP EUR 16.00 100964-99-0 JOYSTICK KNOB MUSHROOM EUR 27.00 100963-99-0 JOYSTICK KNOB SOFT BALL EUR 27.00 100965-99-0 JOYSTICK KNOB STICK EUR 27.00 100961-99-0 JOYSTICK KNOB T-GRIP EUR 42.00 105442-99-0 JOYSTICK SOFTBALL BLACK WITH CONE EUR 24.00 Attendant control Attendant control (+) 104223-99-0 JOYSTICK ATTENDANT VR2 EUR 931.00 Supplementary accessories Split backrest (+) 100972-99-0 SPLIT BACKREST EUR 119.00 Chest support table (+) 101303-99-0 CHEST SUPPORT FOR TABLE CII/VII VINYL EUR 189.00 Permolock Permolock C3 (+) 104022-99-0 PERMOLOCK C3 WITH STANDARD SWITCH EUR 904.00 Manual Permolock (+) 104722-99-0 USER MANUAL ES 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 (+) 102864-99-0 SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) 101411-99-0 PERMOLOCK SNAP IN KIT EUR 152.00 Seat adapter (+) 104708-99-0 CAR SEAT ADAPTER PERMOLOCK C3 EUR 339.00 Wheel bump (+) 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 Page 7 of 8

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 8 of 8