R82 Kudu - E1233. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features:

Similar documents
R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

R82 Wombat Living. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Date: Wombat Living Standard Features:

R82 Stingray - E1233

R82 Caribou - E0641. Retail Price List/ Order Form. Account #: Purchase Order No.: Date: Caribou Standard Features:

R82 x:panda. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

R82 Stingray. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: City/State/Zip: Effective: 2/01/ Rev 7.

R82 x:panda. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

x:panda, size 1, med. back X c x:panda, size 1, med. seat 7¼" X c

Canadian Suggested Retail Price List April 2015

Convaid Trekker 2 - HCPCS E1234 Retail Price List / Order Form

Convaid Trekker 2 - HCPCS E1234 Canadian Retail Price List / Order Form

R82 Caribou - E0641. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

R82 Flamingo Flamingo High-Low

R82 Rabbit Up - E0638 / E0642 USD Retail Price List/ Order Form

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan.

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) Freedom 2 Kids

MASS Script Form. Frame. Backrest. Seat Depth. Tsunami ALX K0005 Charge. Sling Position. Seat Width / Seat Depth. Seat Width.

SHIPPING INFORMATION Provider Acct #:

SHIPPING INFORMATION. Order

MASS Script Form. Frame. Backrest. Seat Depth

Phone: Nov-17

SHIPPING INFORMATION Provider Acct #:

Frame Width. Seating Setup. q 16 q 15 q 14 q 17 q 16 q 15 q 14 Short q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14

[ ] Quote [ ] Order. Junior US Retail Price List. Account Information. Ship To Information. Standard Features.

SHIPPING INFORMATION Provider Acct #: Address: ST: ZIP:

Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151.

Customer code C- Invoice address. Max. 90 kg See page 5 Side upholstery (reduces SW with 2 x 2 cm) = Standard equipment

Quickie IRIS January 2014

Basic price 2.250,- Excl. VAT

Please choose the seat width for accessories: 35 cm 40 cm 43 cm 45 cm 50 cm

Quickie IRIS FSS Net Order Form/Price List (SIN F-1)

Phone: Jan 17. Fax: usa.com Quote: P.O. usa.com Bill To

q q q q q q q q q q q q q q q q q q Frame q Titanium Frame K5-CAT5-TITAN $ Includes hangers and base frame. Does not include Cross Braces.

Invacare REA Azalea Transit RETAIL Max User Weight 135Kg (21 stone)

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair

q Little Wave Flip XP - Rigid Base KF-XPRIGID $

NXT Pediatric. Manual Wheelchair. Transport Optional Base

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair

Page 1/133. Price and ordering list. Mustang B (Shoulder height)

BINGO Evolution rehab pushchair

2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018

PAGE 2 BREEZY ELEGANCE

2016 EZ RIDER UPRIGHT PRODUCT PPT

Invacare Action 3 Junior Large Retail Max User Weight 80Kg (12.5 stone) Standard Base Price: 539 * Configurations may vary to the image shown

Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.

Dealer Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

PRESCRIPTION FORM. Delivery address. Purchase order. Shipment date Delivery Date. Type

Shower commode chairs

Invacare Action 3 Junior Basic RETAIL Max User Weight 80Kg (12.5 stone)

Velocity Order Form. Dealer Information Dealer Name ATP Account Number Phone Fax Date PO# Ship to Address City State Zip

Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.

q Little Wave Flip XP-Rigid Base E1233, E1161 $

A growth adaptable wheelchair - for comfort and support

Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

Accessories. Exploded views / Part lists

Standard Base Price: 618

BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e

RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"

Standard Base Price: 539

C300 Corpus Tilt. Please send order/quote to fax#: (800) to: * Indicates a Required Field Dealer Information

4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity)

Invacare Action 3 NG Transit Retail Max User Weight 125Kg (19.7 stone)

BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

Accessories brochure

Spare parts & accessories

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Aquatec Ocean Family. Ocean Family. Aquatec

Black -01 Moss green -95 Yellow -99. Heather purple -97. Indicate height. Indicate height. Indicate angle. Indicate height: cm. Indicate height: cm

Sling Position. Push Handle. q Omit Push Handles N/C q Standard Push Handles 53 q Fold Down Push Handles 80 q Bolt-On Push Handles 109

STELLAR. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Mygo Seat Spare Parts Catalogue

ORDER FORM EIPW25. with CAPTAIN'S SEAT. Print pages 1-10 to exclude pictures. Buyer State Zip

STELLAR GL. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

MEDIchair Northern BC nd Avenue Prince George, British Columbia V2L 3A6 Toll Free

FUZE T50. Order Form USA. Please send your completed order form by to or by fax to

4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by: Marked for: User manual: PO: Postal Code: Phone:

Positioning Components Order Form - ODJFS Only

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight:

October 2018 EIQ2X. Mark For: Submitting for: Quote Order. ADDITIONAL SHIPPING INFORMATION Dealer Contact: Price. Option # 1. FRAME 002RS1 002RS2

Jupiter. Uncompromised comfort and postural support in keeping with a contemporary home setting

FUSION Seating Prescription Form Custom Built Seating System

FUZE T50. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

FUZE T20. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Küschall Ultra Light RETAIL Maximum user weight 130kg (20.5 Stone)

Order no.: ... Date Signature. Posterior seat height

cp tech customised product technology Product Catalogue

Kimba. T h e K i m b a F a m i l y o f P e d i a t r i c M o b i l i t y P r o d u c t s

Aquatec. Ocean Family. Flexible, modular shower chair commode solutions

MEDmobility Calgary Trail NW Edmonton AB T6H 2K1 P: F:

Quickie QXi AADL. EIF6, October ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To City: Fax. Price 1. FRAME $2,

Canada Quote / Order Form Combi

Quickie QX July 2017

Manual Wheelchair Pencoed Technology Park. DEALER Prescription form Pencoed. CF35 5AQ. LPF1U2ULTRALIGHT211113D Tel: Fax:

4.6. Clinician/ATP/RTS: City: State: C2MA029 * Required

Start M2S. Lightweight wheelchair. Unit price: EUR X,XXX (side panels and footrests included) Provide estimate only Order. Standard equipment

APEX 4.6. FRONT Seat-to-floor height Caster sizes Height available +- 1/4" ORDER FORM - International. 3" Caster. Specify desired height:

Transcription:

Account #: Purchase Order No.: Contact: R82 Kudu - E1233 CAD Retail Price List/ Order Form Date: Mark For: Bill To: Address: City/State/Zip: Phone: Email Ship To: Address: City/State/Zip: Phone: Kudu Standard Features: Tilt-in-Space - 45 Degrees Solid Seat Pan 12.5", 20", 22" or 24" Wheels Two-Piece Push Handle Quick Release 20", 22" or 24" Wheels Height & Angle Adjustable Foot Supports Choice of 3 Frame Colors Wheel Locks Recline No HCPCS Code Assigned to Kudu sz 4 95 X X X X X X X Kudu size 1 1 Kudu size 2 2 Kudu size 3 3 Kudu size 4 4 White 1 Red 2 Grey 3 Kudu Seat & Back Cushions 1 Omit Seat Cushion 2 One-Piece Height Adj. Push Handle (upcharge) 1 Two-Piece Push Handle 2 One-Piece Footplate, Centrally Mounted 1 Individual Footplates (n/a on size 1) 2 12.5" Solid Wheels* 0 20" Solid Wheels w/quick Release 4 22" Solid Wheels w/quick Release 6 24" Solid Wheels w/quick Release 8 *Only available with drum brakes and fixed axles High Mount Wheel Lock (20", 22" or 24") 1 Drum Wheel Lock 12 1/2" 2 6" Solid Front Castors 1 7" Solid Front Castors** 2 **n/a with 12.5" or 20" rear wheels Page 1 of 5

Kudu Price Configuration Required Items Price HCPCS Kudu Base $2,895 E1233 Recline $480 E1014 Solid Planar Back and Back Cushion $525 E2291 Planar Seat Cushion* $295 E2292 One-Piece Height Adjustable Push Handle $55 Two-Piece Push Handle $0 Center Mount Leg Support $0 Individual, Removable, Swing-Away Leg Support $0 Adjustable Individual Angle Footplate^ $179 K0040 One-Piece Footplate $115 K0040 Airless Insert Wheels (all sizes) $75 E2216 Wheel Locks, High Mount, 20", 22" & 24" $0 Drum Wheel Lock 12.5" $0 6" or 7" Solid Front Casters $0 Turnable Anti-Tip Device $140 E0971 *Only required if seat and back cushions selected ^n/a on size 1 Back Cushion(s) (A) (B) Back Cushion w/cover (A)* 1 $0 95741-160 Back Cushion w/cover (A)* 2 $0 95741-260 Back Cushion w/cover (A)* 3 $0 95741-360 Back Cushion w/cover (A)* 4 $0 95741-460 Back Extension Cushion, + 2" (B) 1 $65 $81 95743-105 Back Extension Cushion, + 4" (B) 1 $65 $81 95743-110 Back Extension Cushion, + 2" (B) 2 $65 $81 95743-205 (C) Back Extension Cushion, + 4" (B) 2 $65 $81 95743-210 Back Extension Cushion, + 2" (B) 3 $65 $81 95743-305 Back Extension Cushion, + 4" (B) 3 $65 $81 95743-310 Back Extension Cushion, + 2" (B) 4 $65 $81 95743-405 Back Extension Cushion, + 4" (B) 4 $65 $81 95743-410 Back Wedge, 6" x 2.5", Pair (C) 1, 2 $32 $40 E63012-60 Back Wedge, 12" x 2.5", Pair (C) 3, 4 $32 $40 E63013-60 (A)* Required only if Kudu Seat Cushion omitted Transit Required Item Transit $200 95900-10 Pelvic Positioning (A) (B) Hip Supports/ Width Reduction, Pair (A) 1, 2 $287 95713-10 Hip Supports/ Width Reduction, Pair (A) 3, 4 $287 95713-20 Upholstered Hip Belt, 1" End Girth (B) 1 $121 85424-1 4-Point Padded Hip Belt (9-10.25" x 21.5") (C) 0 $168 85427-0 (C) (D) 4-Point Padded Hip Belt (10.25-11.25" x 21.5" ) (C) 1 $168 85427-1 4-Point Padded Hip Belt (12-13.5" x 21.5" x 19.5") (C) 2 $168 85427-2 4-Point Padded Hip Belt (14-15.5" x 21.5" x 19.5") (C) 3 $168 85427-3 Pelvic Harness (6.75" X 13.75") (D) X-Small $306 89108-0 (E) Pelvic Harness (8.5" X 16.5") (D) Small $306 89108-1 Pelvic Harness (10.5" X 16.75") (D) Large $306 89108-2 Belt Harness, Neoprene (6.75" X 10.5" X 9.75") (E) 1 $249 89114-1 Belt Harness, Neoprene (7.75" X 13.25" X 11.75") (E) 2 $249 89114-2 Belt Harness, Neoprene (9" X 14" X 13.25") (E) 3 $249 89114-3 Page 2 of 5

Foot & Leg Positioning (A) (B) Pommel (A) 0 $202 95430-0 Pommel (H: 3.5" x D: 3.5" x B: 3.5") (A) 1 $202 95430-1 Pommel (H: 3.5" x D: 4.75" x B: 3.5") (A) 2 $202 95430-2 Pommel (H: 3.5" x D: 6" x B: 3.5") (A) 3 $202 95430-3 Pommel (H: 3.5" x D: 7" x B: 3.5") (A) 4 $202 95430-4 (C) (D) Pommel, Knee Abduction (B) One Size $202 95430-10 Pommel Padding for Knee Abduction (C) One Size $81 95430-10260 Adductors One Size $249 95429-10 (E) (F) Calf Support for One-Piece Footplate (D) One Size $151 85131 Calf Support for Individual Footplates (E) One Size $76 85131-10 Heel Band for Individual Foot Plates (F) One Size $76 85132-10 (G) (H) Upholstered Ankle Strap (W: 7¾") (G) 1 $231 85426-1 Upholstered Ankle Strap (W: 9¾") (G) 2 $231 85426-2 Upholstered Ankle Strap (W:11½") (G) 3 $231 85426-3 Upholstered Ankle Strap (G) 4 $231 85426-4 (I) Formed Footplates, 8.5" Long (H) $206 86147 Formed Footplates, 9.5" Long (H) $206 86148 Neoprene Sandals, Set (I) One Size $162 85696-1 Head Support (A) (B) Anatomic Head Support (5.5" x 5.5" x 9.5") (A)* Small $318 5099001 Decutex Cover, black (Required) Small $0 9923-83 Anatomic Head Support (6" x 5.5" x 10") (A)* Medium $318 5099002 Decutex Cover, black (Required) Medium $0 9945-83 Anatomic Head Support (6.5" x 5.5" 2 12.5") (A)* Large $318 5099003 (C) Decutex Cover (Required) Large $0 9967-83 Headband System (B)** $287 99500 Extra Headband Strap (B)** $70 99400-5 Turtle Bar System, Long (C)* $287 98619-26 Head Support Bracket for OEM (Other Equip. Manuf) $76 87590 (A)* Required Decutex Cover (B)** Only available with Anatomic Head Support Trunk Positioning (A) (B) Fixed Laterals, Pair, Black (A) 3½" x 4" $181 95401-10 Fixed Laterals, Pair, Black (A) 4¾" x 5½" $181 95401-20 Fixed Laterals, Pair, Black (A) 6¼ x 5¾ $181 95401-30 Snap Lock for Laterals, Pair (fits 95401-10, 95401-20) (B) $121 8910702-20 Snap Lock for Laterals, Pair (fits 95401-30) (B) $121 8910702-25 (C) (D) Swing-Away Lateral Support Bracket, Right (C) $281 831000-R Swing-Away Lateral Support Bracket, Left (C) $281 831000-L Bar, Straight, Long, Each (D)* 4 ¾" $0 81932 Bar, Offset, Each (E)* 1" x 4 ¾" $0 81968 (E) (F) Bar, Offset, Each (F)* 1¾" x 4 ¾" $0 82000 Bar, Offset, Each (G)* 2½" x 4 ¾" $0 81969 Polyurethane Cushion Pads, Each (H)** 3½" x 7.2" $131 6175406 Polyurethane Cushion Pads, Each (H)** 2½" x 6 ¾" $131 6175405 (G) (H) Polyurethane Cushion Pads, Each (H)** 2½" x 6" $131 6175404 Protective Cushion for Lateral Hrdw, Black, Pair (I) $115 89150 Lateral Pad Belt 1" $57 84120-25 Lateral Pad Belt 1½" $57 84120-40 Cross Vest (W: 4.5" X D:.5" X H: 11") (J) 0 $237 89625-060 (I) (J) Cross Vest (W: 5" X D:.5" X H: 12") (J) 1 $237 89625-160 Cross Vest (W: 5.2" X D:.5" X H: 12.75") (J) 2 $237 89625-260 Cross Vest (W: 6.25" X D: 4.75" X H: 15.25") (J) 3 $237 89625-360 Cross Vest (W: 7.5" X D: 6.75" X H: 18.25") (J) 4 $237 89625-460 Page 3 of 5

Trunk Positioning Continued Vest (W: 1.25" X D: 2.5" X H: 5.5") (K) 0 $249 89111-060 Vest (W: 1.5" X D: 2.5" X H: 5.75") (K) ¾" $249 89111-07560 Vest (W: 2.25" X D: 2.5" X H: 7") (K) 1 $249 89111-160 (K) (L) Vest (W: 2.5" X D: 3.5" X H: 9.25") (K) 2 $249 89111-260 Vest (W: 2.75" X D: 4.75" X H: 11") (K) 3 $249 89111-360 Vest (W: 2.75" X D: 6.75" X H: 13.75") (K) 4 $249 89111-460 Neoprene Vest (W: 7" X D: 5.5" X H: 4") (L) 1 $249 89113-1 Neoprene Vest (W:6.5" X D: 9" X H: 6.75") (L) 2 $249 89113-2 (M) (N) Neoprene Vest (W: 11.5" X D: 7.75" X H: 7") (L) 3 $249 89113-3 Sternum Belt (W: 9.25" X D: 6.75" X H: 2.75") (M) 0 $150 85430-0 Sternum Belt (W: 14" X D: 2.25" X H: 2.25") (M) 1 $150 85430-1 Sternum Belt (W: 18" X D: 2.25" X H: 2.5") (M) 2 $150 85430-2 Chest Belt, Upholstered (11.25" x 7.5" x 19.25-12") (N) 1 $337 85428-1 Chest Belt, Upholstered (14"x 10.25" x 10.25-12.75") (N) 2 $337 85428-2 Chest Belt, Upholstered (16.25" x 12.5" x 10.25-12.75") (N 3 $337 85428-3 Chest Belt, Upholstered (20.25" x 16" x 11.25-14.5") (N) 4 $337 85428-4 (D, E, F, G)* Required with Swing-Away Bracket, select 1 (H)** Required with Swing-Away Bracket, select 1 Frame Option (A) (B) Armrest w/side Plates & Holders for Tray, Pair (A) 1, 2 $256 95712-2 Armrest w/side Plates & Holders for Tray, Pair (A) 3, 4 $256 95712-4 Angle Adjustable Armrest, Pair (B)* 1, 2 $443 95712-20 Angle Adjustable Armrest, Pair (B)* 3, 4 $443 95712-40 (B)* Includes Side Plates & Holders for Tray Accessories (A) (B) 20" Mud Guards, Pair (A) One Size $499 952020 22" Mud Guards, Pair (A) One Size $499 952022 24" Mud Guards, Pair (A) One Size $499 952024 Mud Guards for 22" with 7" Front Castors, Pair One Size $499 952022-7 Mud Guards for 24" with 7" Front Castors One Size $499 952024-7 (C ) (D) Tray with Hardware (B) 1, 2 $430 9576351 Vent Tray (44lbs. Weight Limit) (C) 2, 3, 4 $561 95281-10 Backpack (D) 1, 2 $94 94480-1 Backpack (D) 3, 4 $94 94480-2 20" Spoke Protectors, Each (E) One Size $143 95930-20 (E ) 22" Spoke Protectors, Each (E) One Size $143 95930-22 24" Spoke Protectors, Each (E) One Size $143 95930-24 When being transported in a vehicle, it is R82's position that the wheelchair user transfer from the wheelchair into appropriate vehicle seating during transportation. Please note that at this time, the Department of Transportation has not officially approved any tie-down system for a user while in a wheelchair; therefore R82 cannot recommend a transit system. The R82 Kudu mobility base was tested with the Kudu seating module equipped with a head support and wheelchair anchored pelvic belt and R82 transit anchors. The performance and safety of accessories and/or other seating options not tested by R82 is unknown, and no warranty or claim about their performance is or can be made. For shipping rates, please call 1-844-876-6245 PO Box 1739 Matthews, NC 28106 1-844-876-6245 Fax: 704-882-0751 Prices in USD & is subject to change without notice www.r82.com Effective: 4/26/2017 Rev 2 Page 4 of 5

Measurements Size 1 Size 2 Size 3 Size 4 inches inches inches inches Seat width (A) 10" 11¾ " 13¼" 15" Seat width with hip supports (accessories) 7-10" 7-11½ " 7-13" 7-15" Seat depth (B) 8½-12½" 10½-14½" 12-16" 13½-17½" Back height (C) 14½-18" 15½-20" 16½-22½" 17-24½" Lower leg length (D): Footplate, centrally mounted 6-12" 6-14½" 10-17½" 10-17½" Individual Footplates N/A 9½-13½ 11½-18¾ 11½-18¾ Seat height above floor (E) 18¾" 18¾" 18¾" 18¾" Width (G) 23" 24½" 26" 27½" Length (H) 27" 27" 29" 29" Height (I) 37" 37" 37" 37" Weight 42 lbs. 46 lbs. 51 lbs. 55 lbs. Max. user weight/load 88 lbs. 110 lbs. 132 lbs. 132 lbs. Max. user weight in transportation 88 lbs. 110 lbs. 125.5 lbs. 125.5 lbs. Back recline -5 to +30-5 to +30-5 to +30-5 to +30 Seat tilt -3 to +45-3 to +45-3 to +45-3 to +45 Camber angle for 20, 22, 24 inch wheels 6 6 6 6 Page 5 of 5