Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) ZIP: Ship T City: SUBMITTING FOR: Qute Order Cnfirm Via: Fax Email Ship T Phne: ( ) Fax: ( ) Mark Fr: Zippie X'Cape January 2019 EIFZ1 Ship T: Attentin: Address: Address: The HCPCS CODES prvided are based n cde verificatin thrugh PDAC r ur interpretatin f the cde definitins. The use f HCPCS CODES des nt ensure cverage r payment. Fr cverage infrmatin, verify the apprpriate payer's cverage plicy. PO#: ST: ZIP: a Optin # HCPCS Definitin Price a Optin # HCPCS A. Zippie X'CAPE - TRANSIT ILUDED 165 lbs. Weight Capacity 1. FRAME Definitin B. Zippie X'CAPE - TRANSIT OPTIONAL 165 lbs. Weight Capacity Price A. FRAME STYLE (Includes True Fit) (N/A w/ Xtender) 121WM87 E1238 X'CAPE - Transit Incl. withut seating (Custm seating pts available) 121WM84 E1236 X'CAPE - Transit Incl. w/ Seating (Sling and Back Uph.) Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 15"-18" widths = K0005 $2,385 121WM83 $2,535 121WM85 E1236 B. FRAME STYLE (Includes True Fit) E1238 X'CAPE - Transit Opt. withut seating (Custm seating pts available) X'CAPE - Transit Opt. w/ Seating (Sling and Back Uph.) Nte: HCPCS Cdes shwn as submitted. Sme sizes fit ther HCPC cdes i.e. 15"-18" widths = K0005 $2,135 $2,285 121TO48 K0108 TRANSIT SYSTEM WC-19 Transit Opt. (N/A w/ Xtender) $300 121TO40 Omit Transit FRAME TYPE 121FT64 Zippie-Swing Away Frame 121FT65 Zippie-80 Fixed Frnt Frame 2. SIZE/SEATING 2A. FRAME WIDTH 8", 9" and 1 widths N/A with Xtender 121W48 8" (Frame Width Grwth 9"-1) 121W53 13" (Frame Width Grwth 14"-15") 121W49 9" (Frame Width Grwth 1-1) 121W54 14" (Frame Width Grwth 15"-16") 121W50 1 (Frame Width Grwth 1-12") 121W55 15" (Frame Width Grwth 16"-17") 121W51 1 (Frame Width Grwth 12"-13") 121W56 16" (Frame Width Grwth 17"-18") 121W52 12" (Frame Width Grwth 13"-14") 2B/C. SLING DEPTH, FRAME DEPTH AND BACK POST POSITION. See matrix n page 2. 2B. Sling Depth when chsing with Seating Sling must be up t 3" less than r equal t the Frame Depth (C.) 121GJ1 8" 121GJ7 14" 121GJ2 9" 121GJ8 15" 121GJ3 1 121GJ9 16" 121GJ4 1 121GJ10 17" 121GJ5 12" 121GJ11 18" 121GJ6 13" 2C. Frame Depth and Back Pst Psitin with Grwth Nte: Must be equal r greater than Sling Depth if chsen with seat Sling 121FD40 8"-1 Frame Depth with 2,22" r s and Custm Seating must have hublck r Fixed Frnt frame. When selecting Frame Depth with custm seating, add t accmmdate seating. Example: need 12" depth, rder 13" depth. 121FD41 121FD42 121FD43 8" (Frame depth grwth 9"-1, N/A w/ s) 9" (Frame depth grwth 1-12", N/A w/ s) 1 (Frame depth grwth 1-13") 1 (Frame depth grwth 12"-14") 121FD44 12" (Frame depth grwth 13"-15") 121FD45 13" (Frame depth grwth 14"-16") 121FD46 121FD47 121FD48 121FD49 121FD50 14" (Frame depth grwth 15"-17") 15" (Frame depth grwth 16"-18") 16" (Frame depth grwth 17"-19") 17" (Frame depth grwth 18"-2) 18" (Frame depth grwth 19"-2) Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 1
121OP01 121OP04 Seat Sling Standard Seat Sling Omit Seat Sling (available when base is rdered with seating) SEATING 8" 9" 1 1 12" 13" 14" 15" 16" 8" 8" 9" 9" 1 1 Cushins 1 1 Sme limitatins may exist n 2" Cushin and smaller widths 12" 12" 121CU30 K0669 Fam Cushin $120 13" 13" 121CU31 K0669 2" Fam Cushin $120 14" 14" 15" 15" JAY Cushins (Optinal) 16" 16" T rder any ther JAY cushins n-chair, please see the JAY price list. 17" 17" Cushin name r part number must be filled ut w/ desired width and depth 18" 18" JAY Bundled Cushin 8" 9" 1 1 12" 13" 14" 15" 16" 121JC20 Cushin Name r Part# Price List Width Width (in.): Depth (in.): cushin available at these sizes cushin N/A at these sizes Frame Length Seat Sling t Frame Depth Matrix Difference frm frnt f frame t frnt f sling Sling Length STD 8" 9" 1 1 12" 13" 14" 15" 16" 17" 18" 9" 9" 8" 1 1 9" 1 1 1 12" 12" 1 13" 13" 12" 2" 2" 14" 14" 13" 3" 2" 15" 15" 14" 3" 2" 16" 16" 15" 3" 2" 17" 17" 16" 2" 18" 18" 17" 8" 9" 1 1 12" 13" 14" 15" 16" 18" 3.CASTERS/SEAT HEIGHT Sling Depth Sling Depth Sling and Cushin Matrix Width 2" Cushin Matrix Width 8" 9" 1 1 12" 13" 14" 15" 16" 8" 8" Width 2" cushin available at these sizes 2" cushin N/A at these sizes Sling Depth Sling Depth Caster Wheel Frnt Seat Heights Matrix 121CW30 3" Micr Light Up Frnt Caster 121CW3 4" Lw-Prfile Plyurethane Rear Wheel Size 121CW31 4" Micr Light Up $70 3" 4" 5" 6" 121CW64 4" x 1-1/2" Aluminum Sft Rll $185 13. 13. 14. 15. 121CW5 5" Lw-Prfile Plyurethane 13.5" 13.5" 14.5" 15.5" 121CW51 5" Micr Light Up $85 14. 14. 15. 16. 121CW6 E2219 5" Sft Rll (Grey) $90 12" 14.5" 14.5" 15.5" 16.5" 121CW7 E2219 5"x1-1/2" Semi-Pneumatic $85 16" 15. 15. 16. 17. 121CW66 5"x1-1/2" Aluminum Sft Rll $195 2 15.5" 15.5" 16.5" 17.5" 121CW34 6" Ply 22" 16. 16. 17. 18. 121CW35 E2219 6"x1-1/2" Semi-Pneumatic $85 16.5" 16.5" 17.5" 17. 17. N/A N/A N/A 17.5" Caster Frks 14. 15. N/A N/A 121CF65 Multiple Psitin 14.5" 15.5" 14. 14. 15. 16. 14.5" 14.5" 15.5" 16.5" 15. 15. 16. 17. 15.5" 15.5" 16.5" 17.5" 16.5" 16.5" 17. 18. 17. 17. 17.5" N/A 17.5" N/A N/A Standard Frame Hemi Fame (N/A w/ 90 hanger, 80 hanger ftplate in lwest psitin may cause interference w/caster) Depends n Caster setting FRONT SEAT HEIGHTS ARE SHOWN IN THE BOXES IN THE FRONT SEAT HEIGHTS MATRIX. DEPENDING ON CG SETTING, SEAT DEPTH, AND FRAME SIZE SOME OF THE SIZES MAY NOT BE AVAILABLE Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 2
4.REAR WHEELS/SEAT HEIGHT Please select ne f the fllwing handrim ptins 121XH5 Plastic Cated 121XA4 121XT6 121XT7 121XH6 Stainless Steel 121XA11 Spare Li-in Pwer Pack - LITHIUM $1,795 121XA9 E0986 E0986 121XT4 E0986 121XT5 E0986 121XA10 Spare NiMH Pwer Pack - NICKEL $1,395 E2213 E2213 22" Xtender Pwer Assist JWX-2 NICKEL 22" Xtender Pwer Assist JWX-2 LITHIUM Xtender Pwer Assist JWX-2 NICKEL Xtender Pwer Assist JWX-2 LITHIUM Xtender - Other Optins Xtender Wheel Optins $7,895 $8,695 $7,895 $8,695 121XA8 SPARE 22" Lite Spke Pneu Alum SPARE 22" Lite Spke Pneu Plastic $90 121XA2 SPARE Lite Spke Pneu Alum SPARE Lite Spke Pneu Plastic $90 N/A W/ Xtender & 5 Spke Mag Wheels. N/A w/ Hub Lck. Std Mag Wheels nly available with One Arm Drive. s. N/A with 8" and 9" frame depths. 8"-12" Frame Depth with 20- Rear Wheels and ELR's is ONLY available with Hub Lck Wheels. 121RW48 12" Mag (Nt available with handrims r ne arm drive) $55 121RW3 XTENDER POWER ASSIST OPTION 22" & s nly. RSH 14" t 16" fr 22", RSH 15. t 17" fr. 0 camber, pneumatic tire. Anti-Tips n charge. Dual drive mde available thrugh B4Me. 121RW14 121RW8 121RW1 121RW103 121RW104 121RW102 121RW74 121RW75 121RW76 121RW06 121RW10 121RW28 121RW95 121RW32 121RW98 Xtender Pwer Assist Rear Wheels 16" Mag (Nt available with handrims r ne arm drive) 2 Mag Wheel 22" Mag Wheel Mag Wheel 5 Spke 22" Lite Spke Wheel 22" Spinergy LX Black Spkes $55 Mag Wheel 2 Mag Wheel 5 Spke 22" Mag Wheel 5 Spke 2 Lite Spke Wheel Lite Spke Wheel 22" Ultra light wt. Spke Wheel 2.0 Ultra light wt. Spke Wheel 2.0 22" Spinergy SPOX Black Spkes Spinergy SPOX Black Spkes Spinergy LX Black Spkes $250 $250 $820 $820 $1,025 $1,025 Tire Schwalbe Marathn Plus Schwalbe Speed Run 121RT21 121RT4 Full Ply Tire SHOX Perfrmance Ply Lw Ply 121RT3 121RT6 121RT27 High Pressure Clincher Knbby V-TRAK Pneumatic 121RT38 121RT1 121RT2 121RT28 Pneumatic Airless Insert 121HR4 121HR23 121HR24 121HR7 Wheel N/A w/ Xtender. Natural Fit N/A w/ 2 and 22" 5 Spke Mag Wheel 121HR1 121HR22 121HR30 121HR31 121AL33 E2212 E2212 E2218 E2213 E2212 E2212 Rear Wheel Tire Full Ply Tire High Pressure Clincher Knbby V-TRAK by Kenda SHOX Perfrmance Ply Pneumatic Pneumatic Airless Insert Schwalbe Marathn Plus Evlutin Schwalbe Speed Lw Ply 5 Spke Mag Std. Mag 12",16", 12" 22" = 489 mm = 540 mm Handrim Aluminum Andized Natural Fit LT - Super Grip (N/A n Ultra Lite r 2 Lite Spke) Spinergy Flex Rim (Only n Spinergy LX) Axle Plate Lite Spke Plastic Cated (N/A n Ultra and 22" Spinergy LX,SPOX) Natural Fit -Standard Grip (N/A n Ultra Lite r 2 Lite Spke) Natural Fit - Super Grip (N/A n Ultra Lite r 2 Lite Spke) Standard 12",16", Natural Fit LT - Standard Grip (N/A n Ultra Lite r 2 Lite Spke) Omit Handrim (Optin may nt be available n all rear s) Ultra Lightweight $100 $415 $475 $650 $95 $95 $95 $85 $140 $125 Spinergy $395 $425 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 3
121OA2 Standard Handrim 121HM1 Right Hand Munt 121HM2 Left Hand Munt 121OA1 Small Handrim (N/A w/ 2 rear s) 121HM1 Right Hand Munt 121HM2 Left Hand Munt 121AL16 121AX1 Quick Release (N/A w/ One Arm Drive) 121RH26 17.5" Quad Quick Release (Only Available 121RH20 18" 121AX11 $125 with 12" and 16" Mag Wheels) 121CC16 121CC15 121CC17 E0958 One Arm Drive NA w/ Xtender. N/A w/ 12"-16" s. Only avail. On 12"-16" widths and 2, 22" and mag s.n/a with Natural Fit handrims.n/a with SPHA arms 121CC28 121CC26 One Arm Drive Axle 4.REAR WHEELS/SEAT HEIGHT Cnt. $900 Center f Gravity Preset (dependent n s, casters & depth, Frm standard frame depth +2" frward and - depth grwth up t -3" ) 121CC20 121CC18 0 (Flush w/ backrest) (Only avail 9"-18" deep) (Only avail 1-18" deep) 1.5" (Only avail 1-18" deep) 2" (Only avail 16"-18" deep) 2.5" (Only avail 16"-18" deep) Rear Wheel 12" lw ply 12" pneu 16" 2 22" pneu 121RH32 121RH33 121RH9 121RH10 121RH11 121RH12 121RH13 121RH14 121RH15 121RH16 121RH17 121RH18 121RH19 Rear Seat Height (see Allwable Squeeze chart) 1 11.5" 12" 12.5" 13" 13.5" 14" 14.5" 15" 15.5" 16" 16.5" 17" Rear Seat Height 1 11.5" 12" 12.5" 13" 13.5" 14" 14.5" 15" 15.5" 16" 16.5" 17" 17.5" 18" When tires are nt listed default t the size. All Heights are subject t vary slightly 121CI1 121CI2 0º Camber 3º (N/A w/ Single Pst Ht. Adj. Arm) Allwable Squeeze (may vary +/- 1/2") Frame Depth Max Squeeze 8"-9" 1-12" 1. 1.5" 13"-15" 2. 16"-18" 2.5" 5. WHEEL LOCK 121LK01 12" Hub Lck $100 121WL1 High Munt Push 121LK02 16" Hub Lck $100 121WL2 High Munt Pull 121LK04 2- Hub Lck Lite Spke $100 121WL30 Cmpact $140 Hub Lck Munt Psitin 121WL10 Omit Hub Lck Only available with 12" r 16" mag s r Lite Spke s. Nt available with Onne Arm Drive. Ft lck may limit flding width. Wheel Lck N/A with Hub Lck. High Munt will be munted in lw psitin n 12 and 16 rear s. Sme may nt be available depending n size and psitin. 121HH01 Ft lck Munt Extensin Handle (Only avail w/ High Munt Wheel Lcks) 121HH02 Seat Munt 121EH1 E0961 6" Pair $75 121HH03 Back Munt (back ht. may be limited) Frame Depth 8" 9" 1 C.G. 1.5" 2 Swing Away 8"-12" Frame Depth Wheel Lck g/n-g matrix 22" Frame Depth 11 12 C.G. 1.5" 1.5" 2 N-g. User must use hublck. G 22" Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 4
6. HANGER AND FOOTREST 121H162 121H160 Z-finity Hangers/Ftrest System N/A n Fixed Frame. Sme interference may exist in certain cnfiguratins. Z-finity Hanger Elevating Hanger - Ext Munt Includes ELR pad. N/A w/ Z-finity. Sme limitatins may exist. 121H144 Omit Hanger Z-finity Ftrest Munt (Must Chse see Illustratin) 121DI22 Direct Hanger Mt/Fixed Frame - High 121DI23 Direct Hanger Mt/Fixed Frame - Lw 121DI24 Extensin Tube Munt Z-finity Ftrest Pivt Arm (Must Chse, use matrix fr leg length) 121DI20 Shrt 2" 121DI21 Lng 3-1/4" Ftplate 121F320 Sme interference may exist in certain cnfiguratins. K0040 Multi-Angle Adjustable - Pair (N/A w/ 8"-9" widths) STD $295 $185 Hanger Munted Ftrest (Ftplates Munt t Hanger Tubing) 121H157 121H158 80 Swing In/Out Frnt Munt 90 Swing In/Out Frnt Munt Extensins (may interfere with sme seat heights & casters) 121E23 2" (nt munted) $55 121E24 4" (nt munted) $55 Ftplate 121F9 K0040 Kids Angle Adjustable (nly available w/ 1-16" frame widths) $185 N/A with 8" and 9" width. Ftplate munted in lwest psitin may cause interference w/ caster. 121F8 K0040 Adult Angle Adj. (nly available with 1-16" widths) $185 121F321 K0040 Angle Adjustable Platfrm Ftbard $190 121F6 Omit Ftplate Extensin Tube Length (When Chsing Ext. Tube Munt) 121E62 Hemi 121E1 Shrt 121E2 Medium 121E5 Lng Z-finity Matrix Direct Hanger Munt Extensin Tube Munt Lng Pivt Arm Shrt Pivt Arm 121HL8 K0038 Ftrest Optins Leg Strap (N/A w/ Adult Angle Adj. ftplates) $40 121HL11 E0951 Heel Lps (N/A w/ Kids Angle Adj. Z-finity. N/A n widths belw 14") $40 Neprene Impact Guards (N/A with 121IG2 $90 ftrest in highest munted psitin) Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 5
7. BACKRESTS BACKREST 121BT10 Standard Backrest (Angle adj./flding) 121BT101 Dynamic Backrest (N/A w/ Fixed Back) $1,195 BACK TYPE (Chse Height Adjustable r Fixed Height) 121BT120 Height Adjustable (see matrix belw) OR 121BT53 Fixed Height Height Adjustable (See Backrest Height Range matrix) Fixed Height Must chse Lwer Base Tube, Backrest Style, and Upper Back Tube. Fixed Height back N/A with uphlstery Lwer Base Tube (See Backrest Height Matrix Belw) 121BP9 Standard (16" Height) 121BP58 Shrt 121BP10 Medium (2 Height) 121BP59 Medium 121BP11 Tall (23" Height) 121BP60 Tall (N/A with Dynamic Backrest) 121BP61 Standard w/ Flding PH (16" Height) $335 121BP62 Medium w/ Flding PH (2 Height) $335 Backrest Styles (See Images Belw) 121BP63 Tall w/ Flding PH (23" Height) $335 121PH16 Straight Nn Push Handle 121PH6 Integral Push handle 121PH17 Flding Push Handle with Ht. Adj. Back (8"-1 widths, strller handle will face utward) $275 121PH15 Omit Back Tube (See mit matrix) Upper Back Tube (See Backrest Height Matrix Belw) 121B245 Shrt 121B5 Medium Fixed Height Fixed Height w/ Flding PH Height Adjustable Backrest Preset Back height (Chse fr Set Up) N Uphlstery w/ 19"- 9" 15" 2 1 16" 2 12" 17" 22" 13" 18" 23" 14" 19" Flding Push Handle Integral Push Handle Upper Back Tube Measured Backrest Height Lwer Base Tube Straight Nn-Push Handle Integral Push Handle Flding Push Handle Omit Back tube Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 6
7. BACKRESTS Cnt. Uph N/A with Fixed Height back. Std Uph N/A w/flip-up, Adj. Lcking Flip-Up and Length Adj Lcking Flip-up. 3DX N/A n 8"-1 widths. Ballistic N/A n 8"-9" widths. 121BU1 121BU71 121BU70 121BU66 E2611 E2611 Back Uphlstery Standard Uphlstery Backrest Tensin Adj. 3DX Vented Backrest Tensin Adj. Ballistic Omit Back Uphlstery STD $330 $315 JAY Back (Optinal) T rder any ther JAY back n-chair, please See the JAY Price Lst. Requires Part # JAY Bundled Backrest 121JB02 Backrest Name r Part # Price List Width (in.): Height (in.): Stabilizer Bar N/A w/ Dynamic back and Fixed Back. Only available w/ Integral push handle. 121SZ1 Stabilizer Bar $105 8. ARMRESTS/SIDEGUARDS Armrest and Armpad - Height Adjustable Flip-Up, Adj. Lcking Flip-Up and Length Adj. Lcking Flip-up N/A with Std Back Uphlstery. Lw RSH in cmbinatin with large s may result in arm interference. SPHA arms N/A with One Arm Drive r Xtender. 121AA58 121AA59 121AA3 121AA1 E0973 Adjustable Lcking Flip-Up 121AA7 E0973 Length Adjust. Lcking Flip-Up 121AA11 121AA29 E0973 T-Pst Xtra Tall(with sideguard) $265 E0973 E0973 E0973 T-Pst 2X Tall(with sideguard) Flip-Up Single-Pst Ht Adj. Std. (N/A w/ 3 camber r 8"-9" frame depths) Single-Pst Height Adj. Lw (N/A w/ 3 camber r 8"-9" frame depths) $265 $265 $275 $285 $285 121SG33 121SG29 121AM23 121AM24 121AM9 121AM10 Side Guard N/A with height adjustable armrests and T-Psts K0108 Plastic Std K0108 Plastic Lw Armpad N/A with T-Pst and Adj. Lcking Flip-Up and Fam nly available with Length Adj. Lcking Flip-Up. Desk Classic Full Classic (N/A w/ 1-13" Depth) Fam Shrt (N/A w/ T Pst) Fam Lng (N/A w/ T Pst) $140 $140 121AA14 Omit Armrest Pad Classic Single Pst Height Adjustable Armrest Armrest Transfer Tube Size Length (D) Range (H) STD 8" 9-1/2" t 14-1/2" LOW 5-1/4" 8" t 12" Pad Length (L) Desk Full 10-1/4" 14" Armrest Size XTALL 2X TALL T-POST Range (H) 6" t 7" 7-1/2" t 8-1/2" Pad Length (L) 7" Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 7
121A1 121A2 1218A03 1213A01 121A2100 121A823 121A824 121A825 Back Pack (ne Backpack Black/Charcal already included) E2207 E0978 E0978 E0978 Black Utility Backpack $75 1211A01 Black Backpack Black/Charcal Kids Caddy (Only avail w/ Ext. Mt. hangers) Tl Kit Miscellaneus Crutch Hlder Psitining Belt Belt 2" Aircraft Buckle $110 Belt 2" Aircraft Buckle Padded $60 $50 $45 $195 Belt Dual Adj. Sqz Blk Pad $85 $120 9. ACCESSORIES 121A826 E0978 Belt 1.5" Aut Buckle $70 Only available with 22" r Spke rear s 121A814 E0978 Cmfrt Fit APB5116 $120 1214A10 1214A11 K0065 K0065 Basketball Chrme Wheels Upper Extremity Supprt Tray N/A with 8"-9" widths 1214A12 1214A13 K0065 K0065 Graffiti Happy Lins 121A29 E0950 X-Small (Suggested 1-12" chair width) $255 1214A14 K0065 Ht Wheels 121A30 E0950 Small (Suggested 13"-14" chair width) $255 1214A15 K0065 Mice n Cheese 121A31 E0950 Medium (Suggested 15"-17" chair width) $255 1214A16 K0065 Princess 121A32 E0950 Large (Suggested 18"-2 chair width) $255 1214A17 K0065 Space Galactica 1214A18 K0065 Super Her 1214A19 K0065 Zebra Frnt Anti-Tip 121AO1 E0971 $150 (N/A with transit pt.) 121AT1 E0971 Seat Puch Anti-Tip Rear Anti-Tip Spke Guard N/A with 12" and 16" rear s r 5 spke mag r Xtender 1214A01 K0065 Black 1214A02 K0065 Clear Zippie Designer Spke Guard $50 $140 $115 $115 10.COLOR (Standard with frame and crss brace clr chices) Frame Clr (Must chse) Crss Brace Clr Standard Clrs Standard Clrs 121C140 Aztec Gld 121C600 Aztec Gld - Crss Brace 121C2 Black (N/A as base w/zebra) 121C601 Black - Crss Brace 121C141 Black Cherry 121C602 Black Cherry - Crss Brace 121C10 Black Opal 121C603 Black Opal - Crss Brace 121C38 Blue Opal 121C604 Blue Opal - Crss Brace 121C36 Candy Blue 121C605 Candy Blue - Crss Brace 121C14 Candy Purple 121C606 Candy Purple - Crss Brace 121C35 Candy Red 121C607 Candy Red - Crss Brace 121C142 Electric Blue 121C608 Electric Blue - Crss Brace 121C143 Evergreen 121C609 Evergreen - Crss Brace 121C126 Glw 121C610 Glw - Crss Brace 121C144 Green Apple 121C611 Green Apple - Crss Brace 121C147 Ht Sparkle Pink 121C612 Ht Sparkle Pink - Crss Brace 121C148 Mauve Pink 121C613 Mauve Pink - Crss Brace 121C103 Rtbeer 121C614 Rtbeer - Crss Brace 121C114 Sparkle Silver 121C615 Sparkle Silver - Crss Brace 121C145 Sunrise Orange 121C616 Sunrise Orange - Crss Brace 121C113 Titanium Clr Paint 121C617 Titanium Clr Paint - Crss Brace 121C8 Yellw 121C618 Yellw - Crss Brace Standard Matte Clrs Standard Matte Clrs 121C116 Matte Black 121C619 Matte Black - Crss Brace 121C151 Matte Black Cherry 121C620 Matte Black Cherry - Crss Brace 121C152 Matte Purple 121C621 Matte Purple - Crss Brace 121C150 Matte Electric Blue 121C622 Matte Electric Blue - Crss Brace 121C149 Matte Evergreen 121C623 Matte Evergreen - Crss Brace Custm Clrs (Must chse crss brace std. clr) 121C108 121C43 Mssy Oak Camuflage $395 121C42 Stars and Stripes $395 Zebra (Chse base clr abve: White Std. N/A Black) $395 Additinal Optins Thrugh Built-4-Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) 333-4000, Fax: (800) 333-9011 Cmmnly Requested Optins Include: Slid Seat Grade Aid Drum Brake Sunrise Medical (US) LLC 2842 Business Park Ave. Fresn, CA 93727 USA Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm Web: www.sunrisemedical.cm Page 8