Quickie QX December 2018

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Quickie QX December 2018 EIF6 Mark For: Submitting for: Quote Order Date: PO#: Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: PV: PC: Address: Dealer Phone: ( ) Fax: ( ) Address: Confirmation Email: Ship To City: PV: PC: Confirm Via: Fax Email Ship To Phone: ( ) Fax: ( ) Option # Definition Price Option # Definition Price 1. FRAME Base Model 196WM94 Quickie QX (Fixed Axle) 265 lbs. $1,857.00 Base Model 196TO38 Transit System WC19 Frame Style See Seat Height Matrix on page 2 196FS9 196FS30 Standard Frame Hemi Frame 2. SIZE / SEATING Frame Width Seat Depth 196W5 14" Frame Depths equals Seat Depths. 196W6 196SD7 14" 196W7 16" 196SD8 196W8 196SD9 16" 196W9 18" 196SD10 196W10 $284.00 196SD11 18" 196W11 20" $284.00 196SD71 196SD13 20" $284.00 $284.00 Frame Width - Built 4 Me Options Weight Capacity 300 lbs. Not available with EXO standard or Tension adjustable JAY Cushions (Optional) upholstery, Not available with Ballistic Nylon or 3DX Tension adjustable upholstery. To order any JAY cushions on-chair, please see the JAY price list. 196W59 B4ME - 21" Width $284.00 Cushion name or part number must be filled out with desired width and depth 196W60 B4ME - 22" Width $284.00 JAY Bundled Cushion 196JC20 Cushion Name or Part # Price List Seat Sling Width: Depth: 196SL1 196SL6 Standard Seat Sling Omit Seat Sling ($21.00) Custom Seating 196QC01 196QC02 196QC03 Surefit Configurefit JayFit Quickie QX, Ultra Lightweight Folding Wheelchair Quickie QX featuring the Jay X2 cushion Page 1 of 5

3. CASTERS / SEAT HEIGHT Front Seat Height See Front Seat Height Matrix. 12.5 & 13.0 only available w/ 60 hanger 12.5" & 13" only available w/ Alum Angle Adj Footplate 196SH34 12.5" 196SH14 16.0" 196SH35 13.0" 196SH15 16.5" 196SH40 13.5" 196SH16 17.0" 196SH41 14.0" 196SH17 17.5" 196SH42 14.5" 196SH18 18.0" 196SH12 15.0" 196SH20 18.5" 196SH13 15.5" 196SH21 19.0" 196SH23 19.5" 196CS1 196CS5 196CS9 Caster Stem Bolt Standard 3/4" 1 1/2" Front Seat Height Matrix 196CW3 196CW44 196CW5 196CW7 196CW34 196CW35 196CW32 196CW39 Caster Wheels 4" Low Profile Polyurethane 4" x 1.25" Semi Pneumatic 5" Low Profile Polyurethane 5" x 1.5" Semi Pneumatic 6" Polyurethane 6" x 1.5" Semi Pneumatic 8" Polyurethane 8" x 1.5" Semi Pneumatic $134.00 Caster Fork 196CF71 3.5" (standard stem bolt only) 196CF12 5.25" 196CF17 6" 196CF23 7" 4. REAR WHEELS / REAR SEAT HEIGHTS Rear Seat Height Rear Wheel Tire See Rear Seat Height Matrix. 12.5" & 18.5" RSH not available with fixed axle. See Rear Tire & Wheel Matrix for availability 196RH9 196RH12 12" 13.5" 196RH11 196RH13 13" 14" 196RT1 196RT2 Pneumatic Pneumatic w/ Airless Insert $228.00 196RH14 14.5" 196RT3 Full Poly 196RH15 196RH16 15.5" 196RT39 High-Pressure Clincher Black $96.00 196RH17 196RH18 196RH19 16" 16.5" Handrim Natural Fit only available w/ 22, 24, 25 Lite Spoke. Plastic N/A w/ 25, 26" 196RH26 17.5" 196HR1 Aluminum Anodized 196RH20 18" 196HR4 Plastic $134.00 196RH21 196HR22 196HR23 Natural Fit - Standard Grip Natural Fit - Super Grip $345.00 $401.00 Rear Wheel Size See Rear Tire & Wheel Matrix for availability 196RW3 196RW8 196RW1 196RW103 196RW104 196RW102 196RW90 196RW91 196RW92 196RW94 196RW25 20" Mag Wheel 22" Mag Wheel 24" Mag Wheel 20" Mag Wheel 5 Spoke 22" Mag Wheel 5 Spoke 24" Mag Wheel 5 Spoke 20" Lite Spoke Wheel 22" Lite Spoke Wheel 24" Lite Spoke Wheel 26" Lite Spoke Wheel Omit $295.00 $295.00 $116.00 ($44.00) Seat Squeeze Matrix Frame Depth Max Seat Squeeze 14" 2.0" - 16" 2.5" - 18" 2.5" - 20" 3.0" Rear Seat Height Matrix Page 2 of 5

4. REAR WHEELS / REAR SEAT HEIGHTS (CONT) Rear Tire & Wheel Matrix One Arm Drive Available only with 24" MBL Lite spoke wheels. Std Aluminum black handrim 196AL16 One Arm Drive Adj. Axle Plate $1,276.00 196HM1 Right Hand Mount 196HM2 Left Hand Mount Axle 196AX1 Quick Release Steel 196AX11 Quad Quick Release Steel N/A on Spoke $168.00 196AX45 Threaded Axle $138.00 5. WHEEL LOCKS 196WL1 196WL2 196WL30 196WL24 196WL23 196WL10 196WL12 Wheel Lock High Mount Push High Mount Pull Compact $150.00 Unilateral Wheel Lock Right $295.00 Unilateral Wheel Lock Left $295.00 Omit Wheel Lock Do Not Mount Extension Handle Ext. handles only available with high mount push or pull wheel locks 196EH7 Extension Handle (Pair) $67.00 6. HANGERS AND FOOTRESTS Front Hangers Footplate mounts with Extension Tube using clamping hardware 196H145 60 Swing In/Out Hanger 196H139 70 Swing In/Out Hanger 196H141 80 Swing In/Out Hanger Articulating Hanger 196H159 N/A w/ Alum Angle Adj Front Mount footplates. Elevating Hanger - Ext Mount 196H160 N/A w/ Alum Angle Adj Front Mount footplates. Elevating Hanger - Front Mount 196H161 Only available w/ front mount alum angle adj footplates and 14"-22" width 196H144 Omit Hanger & Footplate $485.00 Extension Tubes See Lower Leg Length Matrix for range 196E1 Short 196E2 Medium 196E5 Long Footplate Heel loop not included, see Footplate Option section below 196F1 Composite Footplate 196F271 196F3 196F5 196HL12 1968A02 Composite Angle Adj (16"-22"w) Aluminum Angle Adj. Footplate Aluminum Only available w/elevating Legrest Hanger & Footplate Options Adjustable Heel Loop Gel Cover For Hangers (Pair) $162.00 $162.00 $150.00 7. BACKREST / SEATING 196BT10 196BT100 Back Type Standard Angle Adjustable Back Backrest Height 196B5 Med (13"-) 196B9 Tall (16"-20") $329.00 Push Handles Integral Push Handles, Folding Height Adjustable & Omit 8 for Std Backrest, Straight for Angle Adj. Backrest 196PH6 Integral Push Handles Fold-Down Push Handles Only available with Adjustable Upholstery. 196PH5 Used in combination w/angle Adjust only $156.00 avail in 16"-20" back height 196PH17 Folding Push Handle with Ht. Adj. Back $286.00 196PH2 Omit Push Handles Page 3 of 5

7. BACKREST / SEATING (CONT) Back Upholstery 196BU1 Standard Upholstery 196BU88 Standard Upholstery EXO $69.00 196BU70 Backrest Tension Adj Ballistic Nylon $175.00 196BU71 Backrest Tension Adj 3DX Vented $435.00 196BU89 Backrest Tension Adj EXO $414.00 196BU14 Omit Back Upholstery ($21.00) JAY Backs 196JB01 JAY Back (see Order forms) Price List Military Service Patches 196VU1 US Marines Patch 196VU2 US Army Patch 196VU3 US Navy Patch 196VU4 US Air Force Patch 196VU12 US Coast Guard 196VU5 Purple Heart 196VU8 Purple Heart with Marines Patch 196VU9 Purple Heart with Army Patch 196VU10 Purple Heart with Navy Patch 196VU11 Purple Heart with Air Force Patch 196VU13 Purple Heart with Coast Guard 8. ARMREST / SIDEGUARDS Armrest - Padded Swing Away Armpad - For Height Adjustable Some limitations when used with the Angle Adjustable Back in the rear most setting 196AM23 Desk Length (10") Please circle a setting, will default to 11" if no selection is made 196AM24 Full Length - Full (14") 196AA18 Padded Swing-Away STD (9" to 13") $256.00 Setting 9" 10" 11" 12" 13" Armrest Options Armrest - Height Adjustable 1968A01 Gel Cover For Swing Away Arms (pair) $150.00 Flip Back HA Classic N/A w / 14"- depth 196AA104 196AA105 Single Post Ht. Adj - Std (9.75"-14.75") Single Post Ht Adj - Low (8.25"-12.25") 196SG33 Side Guards Plastic - Standard (8.5" High) $173.00 196AA65 Flip Back Ht Adj LITE (10"-) $351.00 196SG29 Plastic - Low (6.5" High) $173.00 196AA103 196AA159 196AA14 Dual Post Flip Back Ht Adj Flip Back Ht Adj Classic (11"-) Omit Armrest $351.00 9. KEY OPTIONS 196AT1 196A1 1961A01 Anti Tips Anti Tips (Pair) $111.00 Pack Accessories Backpack - Black/Charcoal Adult $103.00 Seat Pouch Black $77.00 Positioning Belt 196A141 1.5" Auto Buckle w/ Clamps $90.00 196A804 Positioning Belt Slide Clamps $71.00 Spoke Guards 1964A01 Quickie Black Spoke Guard $145.00 1964A02 Quickie Clear Spoke Guard $145.00 Miscellaneous 1968A03 Caddy $83.00 196A2100 Crutch Holder $106.00 10. COLOR Standard Frame Colors Matte Frame Colors 196C140 Aztec Gold 196C116 Matte Black 196C2 Black (Not avail as base w/zebra) 196C151 Matte Black Cherry 196C141 Black Cherry 196C150 Matte Electric Blue 196C10 Black Opal 196C149 Matte Evergreen 196C38 Blue Opal 196C152 Matte Purple 196C36 Candy Blue 196C14 Candy Purple Custom Frame Color 196C35 Candy Red 196C112 Desert Camouflage $340.00 196C142 Electric Blue 196C43 Mossy Oak Camouflage $340.00 196C143 Evergreen 196C42 Stars & Stripes $340.00 196C126 Glow Zebra (Choose above base color) Std 196C144 Green Apple with White unless above base paint is 196C108 196C147 Hot Sparkle Pink chosen N/A w/ Blk, Matte Black, Blk Opal, $340.00 Titanium) 196C148 Mauve Pink 196C103 Rootbeer 196C114 Sparkle Silver Additional Options Through Built for Me 196C145 Sunrise Orange To inquire about any unique customization for Quickie products, contact: Phone: 196C113 Titanium Color Paint (800) 263-3390, Fax: (800) 561-5834 196C8 Yellow Page 4 of 5

APPENDIX Front Seat Height Matrix Cont. Lower Leg Length Range Matrix Page 5 of 5

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