Quickie QXi AADL EIF6, October 2018 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: Dealer Phone: ( Confirmation Email: Confirm Via: PV: Fax: ( Address: PC: Address: Ship To City: Fax Option # Definition PV: Ship To Phone: ( Email Price Option # PC: Fax: ( Definition Price 1. FRAME 196WM78 Base Model Quickie QXi (Adjustable Axle 265 lbs For sizes use E1236 $2,435.00 Frame Style See Seat Height Matrix on page 2 196FS9 Standard Frame 196FS30 Hemi Frame 196TO38 Transit Transit System WC19 $363.00 2. SIZE / SEATING Frame Width 196W5 196W6 196W7 196W8 196W9 196W10 196W11 17" 20" 196SL1 196SL6 Seat Sling Standard Seat Sling Omit Seat Sling 196QC01 196QC02 196QC03 Custom Seating Surefit Configurfit JayFit Seat Depth Frame Depths equals Seat Depths. 196SD7 196SD8 196SD9 196SD10 17" 196SD11 196SD71 196SD13 20" -$20.00 JAY Cushions (Optional To order any JAY cushions on-chair, please see the JAY price list. Quickie QXi, Ultra Lightweight Adjustable Folding Wheelchair Cushion name or part number must be filled out with desired width and depth JAY Bundled Cushion Price List 196JC20 Cushion Name or Part # Width: Depth: Quickie QXi featuring the Jay ION cushion Page 1
3. CASTERS / SEAT HEIGHT Front Seat Height Caster Stem Bolt See Front Seat Height Matrix. 12.5 & 13.0 only available w/ 60 hanger 196CS1 Standard 12.5" & 13" only available w/ Alum Angle Adj Footplate 196CS5 3/4" 196SH34 12.5" 196SH14 16.0" 196CS9 1 1/2" 196SH35 13.0" 196SH15 16.5" 196SH40 13.5" 196SH16 17.0" Front Seat Height Matrix 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" 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 $98.00 6" Polyurethane 6" x 1.5" Semi Pneumatic $98.00 8" Polyurethane 8" x 1.5" Semi Pneumatic $130.00 196CF71 196CF12 196CF17 196CF23 Caster Fork 3.5" (standard stem bolt only 5.25" 6" 7" 4. REAR WHEELS / REAR SEAT HEIGHTS Rear Seat Height See Rear Seat Height Matrix 196RH9 196RH10 196RH11 196RH12 196RH13 196RH14 196RH15 196RH16 12" 12.5" 13" 13.5" 14.5" 15.5" 196RH17 196RH18 16.5" 196RH19 17" 196RH26 17.5" 196RH20 196RH27 18.5" 196RH21 Rear Seat Height Matrix Rear Wheel Size Std Frame Hemi Frame 20" Rear Wheel 13.0" - 16.5" 12.0" - 15.0" 22" Rear Wheel 14.0" - 17.5" 12.5" - 16.0" 24" Rear Wheel 15.0" - 18.5" 13.5" - 17.0" 25" Rear Wheel 15.5" - 19.0" 14.0" - 17.5" 26" Rear Wheel 16.0" - 19.5" 14.5" - 18.0" Rear Wheel Tire See Rear Tire & Wheel Matrix for availability 196RT1 Pneumatic 196RT2 Pneumatic w/ Airless Insert $221.00 196RT3 Full Poly 196RT39 High-Pressure Clincher Black $93.00 Rear Wheel Size 196RT21 Schwalbe Marathon Plus Evolution See Rear Tire & Wheel Matrix for availability 196RW3 196RW8 20" Mag Wheel 22" Mag Wheel Handrim Natural Fit only available w/ 22, 24, 25 Lite Spoke. Plastic NA w/ 25, 26" 196RW1 24" Mag Wheel See Apendix for Rear wheel / Handrim matrix 196RW103 20" Mag Wheel 5 Spoke 196HR1 Aluminum Anodized 196RW104 22" Mag Wheel 5 Spoke 196HR4 Plastic $130.00 196RW102 24" Mag Wheel 5 Spoke 196HR22 Natural Fit - Standard Grip $346.00 196RW90 20" Lite Spoke Wheel $286.00 196HR23 Natural Fit - Super Grip $389.00 196RW91 22" Lite Spoke Wheel $286.00 196HR32 Natural Fit - No Thumb Grip $422.00 196RW92 24" Lite Spoke Wheel 196HR26 The Surge - Oval w/gription Strip $446.00 196RW93 25" Lite Spoke Wheel 196HR27 The Surge LT - Oval w/gription Strip $488.00 196RW94 26" Lite Spoke Wheel $113.00 196HR28 Q-Grip Neoprene Coated $403.00 196RW25 Omit -$43.00 Seat Squeeze Matrix Frame Depth Max Seat Squeeze 2.0" - 2.5" 17" - 2.5" - 20" 3.0" Page 2
4. REAR WHEELS / REAR SEAT HEIGHTS (CONT Rear Tire & Wheel Matrix 196AX1 196AX11 196AX45 Axle Quick Release Steel Quad Quick Release Steel NA on Spoke Threaded Axle $163.00 $134.00 196AS4 196AS5 196AS6 Adjustable Axle Options Adjustable sleeve Fixed Sleeve 0⁰ Fixed Sleeve 3⁰ Center of Gravity Measure from front of back post to center of rear axle One Arm Drive 196CC2 1" Available only with 24" MBL Lite spoke wheels. Std Aluminum black handrim 196CC3 1.5" 196AL16 One Arm Drive Adj. Axle Plate $1,239.00 196CC4 2" 196HM1 Right Hand Mount 196CC5 2.5" 196HM2 Left Hand Mount 196CC6 3" 5. WHEEL LOCKS 196WL1 196WL2 196WL30 196WL24 196WL23 196WL10 196WL12 Wheel Lock High Mount Push High Mount Pull Compact Unilateral Wheel Lock Right Unilateral Wheel Lock Left Omit Wheel Lock Do Not Mount $286.00 $286.00 Extension Handle Ext. handles only available with high mount push or pull wheel locks 196EH7 Extension Handle (Pair $65.00 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 NA w/ Alum Angle Adj Front Mount footplates. 196H160 196H161 196H144 Elevating Hanger - Ext Mount NA w/ Alum Angle Adj Front Mount footplates. Elevating Hanger - Front Mount Only available w/ front mount alum angle adj footplates and -22" width Omit Hanger & Footplate $471.00 -$16.00 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 (-22"w Aluminum Angle Adj. Footplate Aluminum Only available w/elevating Legrest Hanger & Footplate Options Adjustable Heel Loop Gel Cover For Hangers (Pair $157.00 $157.00 206 7. BACKREST / SEATING 196BT10 196BT100 196B5 196B9 Back Type Standard Angle Adjustable Back $319.00 Backrest Height Med (13"-17" Tall (-20" Push Handles Integral Push Handles, Folding Height Adjustable & Omit is 8 for Standard 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 $151.00 avail in -20" back height 196PH17 Folding Push Handle with Ht. Adj. Back $278.00 196PH2 Omit Push Handles Page 3
7. BACKREST / SEATING (CONT Back Upholstery 196BU1 Standard Upholstery 196BU88 Standard Upholstery EXO $67.00 196BU70 Backrest Tension Adj Ballistic Nylon *Reference 186BU70 for billing $379.00 196BU71 Backrest Tension Adj 3DX Vented *Reference 186BU71 for billing $422.00 196BU89 Backrest Tension Adj EXO *Reference XXXBU89 for billing $402.00 196BU14 Omit Back Upholstery -$20.00 196JB01 JAY Backs JAY Back (see Order forms Price List 196VU1 196VU2 196VU3 196VU4 196VU12 196VU5 196VU8 196VU9 196VU10 196VU11 196VU13 Military Service Patches US Marines Patch US Army Patch US Navy Patch US Air Force Patch US Coast Guard Purple Heart Purple Heart with Marines Patch Purple Heart with Army Patch Purple Heart with Navy Patch Purple Heart with Air Force Patch Purple Heart with Coast Guard 8. ARMREST / SIDEGUARDS Armrest - Padded Swing Away Some limitations when used with the Angle Adjustable Back in the rear most setting Please circle a setting, will default to 11" if no selection is made Padded Swing-Away STD (9" to 13" $249.00 196AA18 Setting 9" 10" 11" 12" 13" Armrest - Height Adjustable Flip Back HA Classic NA w / - depth 196AA104 196AA105 Single Post Ht. Adj - Std (9.75"-14.75" Single Post Ht Adj - Low (8.25"-12.25" 196AA65 Flip Back Ht Adj LITE (10"- $341.00 196AA103 Dual Post Flip Back Ht Adj 196AA159 Flip Back Ht Adj Classic (11"- $341.00 196AA14 Omit Armrest 196AM23 196AM24 1968A01 196SG33 196SG29 Armpad - For Height Adjustable Desk Length (10" Full Length - Full ( Armrest Options Gel Cover For Swing Away Arms (pair Side Guards Plastic - Standard (8.5" High Plastic - Low (6.5" High $168.00 $168.00 9. KEY OPTIONS 196AT1 196A1 1961A01 196A141 196A804 Anti Tips Spoke Guards Anti Tips (Pair $108.00 1964A01 1964A02 Quickie Black Spoke Guard Quickie Clear Spoke Guard Pack Accessories Backpack - Black/Charcoal Adult $100.00 Miscellaneous Seat Pouch Black $75.00 1968A03 Caddy $81.00 196A2100 Crutch Holder $103.00 Positioning Belt 1.5" Auto Buckle w/ Clamps $87.00 Positioning Belt Slide Clamps $55.00 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 196C142 Electric Blue 196C43 Mossy Oak Camouflage 196C143 Evergreen 196C42 Stars & Stripes 196C126 Glow Zebra (Choose above base color Std 196C144 Green Apple with White unless above base paint is 196C108 196C147 Hot Sparkle Pink chosen NA w/ Blk, Matte Black, Blk Opal, 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
APPENDIX Front Seat Height Matrix Cont. Lower Leg Length Range Matrix Page 5