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 103263-99-0 C350 PS VR2 BASIC EUR 4,523.00 103437-99-0 C350 PS VR2 ADVANCED EUR 4,846.00 User manual 103760-99-0 USER MANUAL ES C350 EUR - User manual seat 104379-99-0 USER MANUAL ES PS 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 131.00 104871-99-0 WHEEL 3.00-8" MUD/SNOW AIR TIRE (1 pair) EUR 131.00 Drive parameters 103660-99-0 PROGR.SET: C350 VR2/70A ADVANCED 8 KMH EUR - 103661-99-0 PROGR.SET: C350 VR2/70A BASIC 8 KMH EUR - Accessories chassi 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 351.00 _Curb Climber (+) 105443-99-0 CURB CLIMBERS KIT C 350 EUR 385.00 Chassis adaption for Permolock C3 (+) 104626-99-0 ADAPT C300/350 FOR PERMOLOCK C3 EUR 97.00 Reinforcement chassis for Permolock (+) 104637-99-0 REINFORCEMENT C350 CHASSIS FOR PERMOLOCK C3 EUR - Seat assembly Seat lift system 103888-99-0 POWERED SEAT LIFT 200MM C350 / VR2 EUR 1,050.00 103815-99-0 POWERED SEAT LIFT 200MM C350 (COMB. WITH TILT) EUR 1,050.00 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 (+) 103973-99-0 POWERED ADJ.SEAT TILT 30 VR2 EUR 1,212.00 Crush gard seat tilt (+) 103682-99-0 CRUSH PROTECTION SEAT TILT EUR - Seat Page 2 of 5
Model 103875-99-0 SEAT PS EUR - Seat depth 104013-99-0 SEAT DEPTH SET TO 410MM PS EUR - 104014-99-0 SEAT DEPTH SET TO 435MM PS EUR - 104015-99-0 SEAT DEPTH SET TO 460MM PS EUR - 104016-99-0 SEAT DEPTH SET TO 485MM PS EUR - 104017-99-0 SEAT DEPTH SET TO 510MM PS EUR - 104018-99-0 SEAT DEPTH SET TO 535MM PS EUR - Seat width 104610-99-0 SEAT WIDT SET TO 400MM PS EUR - 104611-99-0 SEAT WIDT SET TO 450MM PS EUR - 104612-99-0 SEAT WIDT SET TO 500MM PS EUR - 104613-99-0 SEAT WIDT SET TO 550MM PS EUR - Seat cushion (+) 103297-99-0 SEAT CUSHION 450x560 TEXTILE (MESH) EUR - 103390-99-0 SEAT CUSHION 450x560 VINYL EUR - 103292-99-0 WITHOUT SEAT CUSHION EUR -131.00 Backrest 103879-99-0 BACKREST ADJUSTABLE PS 400MM EUR - 103880-99-0 BACKREST ADJUSTABLE PS 450MM EUR - 103887-99-0 BACKREST SOLID EUR - Backrest cushion (+) 103324-99-0 BACKREST CUSHION 390x535 VINYL EUR - 103326-99-0 BACKREST CUSHION 440x535 VINYL EUR - 103870-99-0 BACKREST CUSHION SOLID BACK VINYL 400MM EUR - 103871-99-0 BACKREST CUSHION SOLID BACK VINYL 450MM EUR - 103872-99-0 BACKREST CUSHION SOLID BACK VINYL 500MM EUR - 103873-99-0 BACKREST CUSHION SOLID BACK VINYL 550MM EUR - 103309-99-0 WITHOUT BACKREST CUSHION EUR -164.00 Mounting set armrests (+) 103683-99-0 MOUNTING KIT ARMRESTS EUR - Armrest bracket right 103667-99-0 AMREST ADJUSTABLE RIGHT EUR - Armrest bracket left 103668-99-0 AMREST ADJUSTABLE LEFT EUR - Armrest Right 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 - 103799-99-0 ARMRESTS NARROW 267MM RIGHT EUR - 103801-99-0 ARMRESTS NARROW 355MM RIGHT EUR - Armrest Left 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 - 103800-99-0 ARMRESTS NARROW 267MM LEFT EUR - 103802-99-0 ARMRESTS NARROW 355MM LEFT EUR - Armrest adapter (+) 103666-99-0 ARMRESTS ADAPTER PS EUR - Legrest 103705-99-0 LEGREST CENTER MOUNTED EUR 242.00 104024-99-0 LEGREST SWING AWAY KNEE ANGLE 70 PS EUR - Adjustment legrest Midline (+) 104642-99-0 MANUAL ADJUSTMENT LEGREST EUR - Footplate (+) 104028-99-0 FOOTPLATES NARROW PS EUR - 104646-99-0 FOOTPLATES NARROW PSJR EUR - 104643-99-0 FOOTPLATES WIDE EUR - Page 3 of 5
Accessories seat Headrest (+) 104131-99-0 HEAD SUPPORT, ADJUSTABLE VINYL EUR 215.00 Lateral support (+) 103062-99-0 LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR 272.00 Thigh support (+) 102977-99-0 THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR 346.00 Thigh support bracket (+) 103680-99-0 BRACKETS FOR THIGH SUPPORTS EUR - Calf support (+) 104683-99-0 CALF SUPPORTS S 110x90 (B)PU FOAM CENT.LEGR. EUR 205.00 104684-99-0 CALF SUPPORTS S 110x90 (B)TEXT.(MESH)CENT.LEGR. EUR 205.00 104685-99-0 CALF SUPPORTS M 165x120 (J)PU FOAM CENT.LEGR. EUR 177.00 104686-99-0 CALF SUPPORTS M 165x120 (J)TEXT.(MESH)CENT.LEGR. EUR 177.00 102982-99-0 CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR 227.00 Calf support bracket (+) 103678-99-0 CALF SUPPORTS BRACKET PS EUR - Seatbelt (+) 104514-99-0 BELT 2-POINT LARGE NONPAD BODYPOINT INCL BRACK UT EUR 99.00 104516-99-0 BELT 2-POINT LARGE PADDED BODYPOINT INCL BRACK UT EUR 142.00 104518-99-0 BELT 2-POINT MEDIUM NONPA D BODYPOINT INCL BRACK UT EUR 92.00 104520-99-0 BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR 134.00 100600-99-0 SAFETY BELT,AUTOTENSION LONG VERSION EUR 118.00 100518-99-0 SAFETY BELT,BUCKLE EUR 49.00 100519-99-0 SAFETY BELT,AUTOTENSION EUR 118.00 Mounting position seatbelt (+) 105010-99-0 MOUNT POS SEATBELT ROLL RIGHT EUR - 105011-99-0 MOUNT POS SEATBELT ROLL LEFT EUR - Mounting kit belt (+) 104749-99-0 TUBE CLAMP KIT EUR 29.00 Push handles (+) 103874-99-0 PUSH HANDLES PS EUR 182.00 Back pack (+) 102059-99-0 BACK PACK INCL. HOOKS EUR 294.00 Bag hooks (+) 105805-99-0 BAG HOOKS OPEN EUR 32.00 Crutch holder (+) 104828-99-0 CRUTCH HOLDER PS PS JR EUR 116.00 Adjustment backrest (+) 104616-99-0 MANUAL ADJUST. BACKREST QUICKLOCK PSJR EUR 117.00 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 (+) 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 - Bracket joystick holder (+) 103681-99-0 JOYSTICK BRACKET EUR - Permolock Permolock C3 (+) 104022-99-0 PERMOLOCK C3 WITH STANDARD SWITCH EUR 861.00 Page 4 of 5
Manual Permolock (+) 104722-99-0 USER MANUAL ES PERMOLOCK C3 EUR - Release lever (+) 102841-99-0 MANUAL RELEASE FOR PERMOLOCK C EUR 170.00 Quicklock holder release lever (+) 102859-99-0 QUICKLOCK HOLDER RELEASE LEVER EUR 54.00 Spacer kit (+) 102864-99-0 SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) 101411-99-0 PERMOLOCK SNAP IN KIT EUR 145.00 Seat adapter (+) 104708-99-0 CAR SEAT ADAPTER PERMOLOCK C3 EUR 323.00 Wheel bump (+) 104707-99-0 WHEEL BUMP FOR PERMOLOCK C3 EUR 28.00 Extension cable Permolock (+) 104232-99-0 EXTENSION CABLE FOR PERMOLOCK C,C3 EUR 54.00 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