Quickie Qxi Nvember 2016 EIF6 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: ADDITIONAL SHIPPING INFORMATION Dealer: Dealer Cntact: Ship T: MEDmbility Reference Only Dealer Address: Attentin: Dealer City: Dealer Phne: ( Cnfirmatin Email: PV: Address: Ship T City: Cnfirm Via: Fax: ( Address: PC: Fax Optin # Definitin PV: Ship T Phne: ( Email Price Optin # PC: Fax: ( Definitin Price 1. FRAME 196WM78 Base Mdel Quickie QXi (Adjustable Axle 265 lbs Fr 14" sizes use E1236 $2,364.00 Frame Style See Seat Height Matrix n page 2 196FS9 Standard Frame 196FS30 Hemi Frame 196TO38 Transit Transit System WC19 $352.00 2. SIZE / SEATING Frame Width 196W5 196W6 196W7 196W8 196W9 196W10 196W11 14" 15" 16" 17" 18" 19" 20" 196SL1 196SL24 196SL6 Seat Sling Standard Seat Sling Seat Sling screw munt Omit Seat Sling -$19.00 Seat Depth Frame Depths equals Seat Depths. 196SD7 14" 15" 196SD8 196SD9 16" 196SD10 17" 196SD11 18" 196SD71 19" 20" 196SD13 JAY Cushins (Optinal T rder any JAY cushins n-chair, please see the JAY price list. Cushin name r part number must be filled ut with desired width and depth JAY Bundled Cushin 196JC20 Cushin Name r Part # Price List Width: Depth: Quickie QXi, Ultra Lightweight Adjustable Flding Wheelchair Quickie QXi featuring the Jay ION cushin Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 1
3. CASTERS / SEAT HEIGHT Frnt Seat Height See Frnt Seat Height Matrix. 12.5 & 13.0 nly available w/ 60 hanger 12.5" & 13" nly available w/ Alum Angle Adj Ftplate 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 Blt Standard 3/4" 1 1/2" Frnt Seat Height Matrix 196CW3 196CW44 196CW5 196CW7 196CW34 196CW35 196CW32 196CW39 Caster Wheels 4" Lw Prfile Plyurethane 4" x 1.25" Semi Pneumatic 5" Lw Prfile Plyurethane 5" x 1.5" Semi Pneumatic $95.00 6" Plyurethane 6" x 1.5" Semi Pneumatic $95.00 8" Plyurethane 8" x 1.5" Semi Pneumatic $126.00 196CF71 196CF12 196CF17 196CF23 Caster Frk 3.5" (standard stem blt nly 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" 14.5" 15" 15.5" 196RH17 16" 196RH18 16.5" 196RH19 17" 196RH26 17.5" 196RH20 18" 196RH27 18.5" 196RH21 19" Rear Wheel Tire See Rear Tire & Wheel Matrix fr availability Rear Wheel Size 196RT21 Schwalbe Marathn Plus Evlutin $137.00 See Rear Tire & Wheel Matrix fr availability 196RW3 196RW8 20" Mag Wheel 22" Mag Wheel Handrim Natural Fit nly available w/ 22, 24, 25 Lite Spke. Plastic NA w/ 25, 26" 196RW1 24" Mag Wheel See Apendix fr Rear wheel / Handrim matrix 196RW103 20" Mag Wheel 5 Spke 196HR1 Aluminum Andized 196RW104 22" Mag Wheel 5 Spke 196HR4 Plastic $126.00 196RW102 24" Mag Wheel 5 Spke 196HR22 Natural Fit - Standard Grip $325.00 196RW90 20" Lite Spke Wheel $278.00 196HR23 Natural Fit - Super Grip $378.00 196RW91 22" Lite Spke Wheel $278.00 196HR32 Natural Fit - N Thumb Grip $410.00 196RW92 24" Lite Spke Wheel 196HR26 The Surge - Oval w/griptin Strip $433.00 196RW93 25" Lite Spke Wheel 196HR27 The Surge LT - Oval w/griptin Strip $474.00 196RW94 26" Lite Spke Wheel $110.00 196HR28 Q-Grip Neprene Cated $391.00 196RW25 Omit -$42.00 Seat Squeeze Matrix Rear Seat Height Matrix Rear Wheel Size Std Frame 20" Rear Wheel 13.0" - 16.5" 22" Rear Wheel 14.0" - 17.5" 24" Rear Wheel 15.0" - 18.5" 25" Rear Wheel 15.5" - 19.0" 26" Rear Wheel 16.0" - 19.5" 196RT1 196RT2 196RT3 196RT39 Pneumatic Pneumatic w/ Airless Insert Full Ply High-Pressure Clincher Black Frame Depth Max Seat Squeeze 14" 2.0" 15" - 16" 2.5" 17" - 18" 2.5" 19" - 20" 3.0" Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 2 Hemi Frame 12.0" - 15.0" 12.5" - 16.0" 13.5" - 17.0" 14.0" - 17.5" 14.5" - 18.0" $215.00 $90.00
4. REAR WHEELS / REAR SEAT HEIGHTS (CONT Rear Tire & Wheel Matrix 196AX1 196AX11 196AX45 Axle Quick Release Steel Quad Quick Release Steel NA n Spke Threaded Axle $158.00 $130.00 196AS4 196AS5 196AS6 Adjustable Axle Optins Adjustable sleeve Fixed Sleeve 0⁰ Fixed Sleeve 3⁰ Center f Gravity Measure frm frnt f back pst t center f rear axle One Arm Drive 196CC2 1" Available nly with 24" MBL wheels.standard Aluminum black handrim 196CC3 1.5" 196AL16 One Arm Drive Adj. Axle Plate $1,203.00 196CC4 2" 196HM1 Right Hand Munt 196CC5 2.5" 196HM2 Left Hand Munt 196CC6 3" 5. WHEEL LOCKS 196WL1 196WL2 196WL30 196WL24 196WL23 196WL10 196WL12 Wheel Lck High Munt Push High Munt Pull Cmpact Unilateral Wheel Lck Right Unilateral Wheel Lck Left Omit Wheel Lck D Nt Munt $142.00 $278.00 $278.00 Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks 196EH7 Extensin Handle (Pair $63.00 6. HANGERS AND FOOTRESTS Frnt Hangers Ftplate munts with Extensin Tube using clamping hardware 196H145 60 Swing In/Out Hanger 196H139 70 Swing In/Out Hanger 196H141 80 Swing In/Out Hanger 196H159 196H160 196H161 196H144 Articulating Hanger NA w/ Alum Angle Adj Frnt Munt ftplates. Elevating Hanger - Ext Munt NA w/ Alum Angle Adj Frnt Munt ftplates. Elevating Hanger - Frnt Munt Only available w/ frnt munt alum angle adj ftplates and 14"-22" width Omit Hanger & Ftplate $457.00 $295.00 $295.00 Extensin Tubes See Lwer Leg Length Matrix fr range 196E1 Shrt 196E2 Medium 196E5 Lng Ftplate Heel lp nt included, see Ftplate Optin sectin belw 196F1 Cmpsite Ftplate 196F271 196F3 196F5 196HL12 1968A02 Cmpsite Angle Adj (16"-22"w Aluminum Angle Adj. Ftplate Aluminum Only available w/elevating Legrest Hanger & Ftplate Optins Adjustable Heel Lp Gel Cver Fr Hangers (Pair $152.00 $152.00 $142.00 7. BACKREST / SEATING 196BT10 196BT100 196B5 196B9 196B249 Back Type Standard Angle Adjustable Back $310.00 Backrest Height Med (13"-17" Tall (16"-20" ExtraTall (18"-22" $130.00 Push Handles Integral Push Handles, Flding Height Adjustable & Omit 8 fr Std Backrest, Straight fr Angle Adj. Backrest 196PH6 Integral Push Handles 196PH5 196PH17 196PH2 Fld-Dwn Push Handles Only available with Adjustable Uphlstery. Used in cmbinatin w/angle Adjust nly avail in 16"-20" back height Flding Push Handle with Ht. Adj. Back Omit Push Handles $147.00 $270.00 Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 3
7. BACKREST / SEATING (CONT Back Uphlstery 196BU1 Standard Uphlstery 196U88 Standard Uphlstery EXO $65.00 196BU70 Backrest Tensin Adj Ballistic Nyln *Reference 186BU70 fr billing $368.00 196BU71 Backrest Tensin Adj 3DX Vented *Reference 186BU71 fr billing $410.00 196U89 Backrest Tensin Adj EXO *Reference XXXBU89 fr billing $390.00 196BU14 Omit Back Uphlstery -$19.00 196JB01 JAY Backs JAY Back (see Order frms Price List Military Service Patches Only available n tensin adjustable uphlstery and Jay 3 Back 196VU1 US Marines Patch 196VU2 US Army Patch 196VU3 US Navy Patch 196VU4 US Air Frce Patch 196VU12 US Cast 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 Frce Patch 196VU13 Purple Heart with Cast Guard 8. ARMREST / SIDEGUARDS Armrest - Padded Swing Away Sme limitatins when used with the Angle Adjustable Back in the rear mst setting Please circle a setting, will default t 11" if n selectin is made Padded Swing-Away STD (9" t 13" $242.00 196AA18 Setting 9" 10" 11" 12" 13" Armrest - Height Adjustable Flip Back HA Classic NA w / 14"-15" depth 196AA104 196AA105 Single Pst Ht. Adj - Std (9.75"-14.75" Single Pst Ht Adj - Lw (8.25"-12.25" $285.00 $285.00 196AA65 Flip Back Ht Adj LITE (10"-15" $331.00 196AA103 Dual Pst Flip Back Ht Adj $295.00 196AA159 Flip Back Ht Adj Classic (11"-15" $331.00 196AA14 Omit Armrest 196AM23 196AM24 1968A01 196SG33 196SG29 Armpad - Fr Height Adjustable Desk Length (10" Full Length - Full (14" Armrest Optins Gel Cver Fr Swing Away Arms (pair Side Guards Plastic - Standard (8.5" High Plastic - Lw (6.5" High $142.00 $163.00 $163.00 9. KEY OPTIONS 196AT1 Anti Tips Anti Tips (Pair $105.00 Pack Accessries 196A1 Backpack - Black/Charcal Adult $97.00 1961A01 Seat Puch Black $73.00 Psitining Belt 196A141 1.5" Aut Buckle w/ Clamps $84.00 196A804 Psitining Belt Slide Clamps $67.00 Spke Guards 1964A01 Quickie Black Spke Guard $137.00 1964A02 Quickie Clear Spke guards $137.00 Miscellaneus 1968A03 Caddy $79.00 196A2100 Crutch Hlder $100.00 10. COLOR Standard Frame Clrs Matte Frame Clrs 196C140 Aztec Gld 196C116 Matte Black 196C2 Black (Nt 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 Custm Frame Clr 196C35 Candy Red 196C112 Desert Camuflage $320.00 196C142 Electric Blue 196C43 Mssy Oak Camuflage $320.00 196C143 Evergreen 196C42 Stars & Stripes $320.00 196C126 Glw Zebra (Chse abve base clr Std 196C144 Green Apple with White unless abve base paint is 196C108 196C147 Ht Sparkle Pink chsen NA w/ Blk, Matte Black, Blk Opal, $320.00 Titanium 196C148 Mauve Pink 196C103 Rtbeer 196C114 Sparkle Silver Additinal Optins Thrugh Built fr Me 196C145 Sunrise Orange T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: 196C113 Titanium Clr Paint (800 333-4000, Fax: (800 333 9011 196C8 Yellw Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 4
11. BUNDLING Save time! Wheelchair and seating will be delivered tgether. Hardware pre-installed. Cushins Jay Cushin: Jay Back: Width: Depth: Width: Ntes: Ntes: Backs Height: Headrest Jay Psitining Cmpnents System: Anterir Trunk Supprts: Pads: Ntes: Hardware: Ntes: Hand and Arm Supprts: Pelvic Psitining: Ft Psitining: Ntes: Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 5
APENDIX Frnt Seat Height Matrix Cnt. Lwer Leg Length Range Matrix Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 6
Specificatins are subject t change withut ntice. Cpyright 2016 Sunrise Medical (US LLC., MK-100024 REV 4 Page 7