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

Similar documents
Quickie 2 AADL - W137

Quickie QX December 2018

Quickie 2 January 2014

Quickie QX July 2017

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

Quickie 2 EIQ2N Effective April 2011

Quickie IRIS January 2014

Zippie Zone July 2018 EIRZ1

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

Quickie Q7 Adjustable March 2014

Quickie GTX Fixed Frame EIF3, Effective July 2009

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.

Quickie GTX Swing-Away FSS NET ORDER FORM/PRICE LIST (SIN F-1)

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.

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

Frame. Backrest. Seat Depth. Little Wave - Clik XP $3600 Width Growable Frame. Price includes one time free growth kit. 165 lb weight capacity.

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

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

Custom Manual Options & ACCESSORIES AUSTRALIA 2013

MASS Script Form. Frame. Backrest. Seat Depth

Account Number: Provider Name: Contact:

Quickie IRIS March 2015

ZIPPIE IRIS (Transit Included) EIZ5A

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

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

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

Account Number: Provider Name: Contact:

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

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

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

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

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

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

UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY.

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

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

BC MEDEQUIP HOME HEALTH CARE LTD SPRINGER AVE, BURNABY, BC

Condor Script Form Folding Frame Day Wheelchair 90050

Condor Script Form Folding Frame Day Wheelchair 90050

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

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: City: Province:

Standard Base Price: 539

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

Zippie Family. Album

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

NOT JUST A WHEELCHAIR. A MEMBER OF THE TEAM.

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

STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD

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

Standard Base Price: 618

Zippie GS. Growth System

Quickie 2HP July 2018

NXT Pediatric. Manual Wheelchair. Transport Optional Base

Town: Postal code: Town: Postal code: CLIENT MEASUREMENTS. Seat Width in cm 38 cm 40 cm 42 cm 44 cm 46 cm. 40 cm

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

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

TiLite. Please Fax to the TiLite Customer Service Team at or

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

YOU RE YOUNG. YOU RE ACTIVE. YOU RE YOU. GROWTH WITH AN EDGE. ROGUE XP.

Quickie QXi July 2018

Product. QUICKIE QRi PAGE 1

SEAT BACKREST. REAR SEAT HEIGHT SELECTION: independant of rear wheel size. Rear seat height in cm (2)

Kids Quickie 2 SE November 2012

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

4.2. Ship to: Vendor: Name: Date: Address: Ordered by: Phone:

4.6. Clinician/ATP/RTS: City: State: VEMA039 * Required. Veloce - FRONT Seat-to-floor height. 16 to 19 Specify desired height: 80.

ORDER FORM Ver.6 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

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.

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.

Zippie Family. Album

Quickie QX February 2019

USA Parts List BENTLEY

Max. user weight: 110Kg / 140kg USER WEIGHT Fax number: +44 (0)

3 A7WC10 E-Motion adaptor Kit (2 adaptors)

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

Stallion Script Form Fixed Frame Adjustable Wheelchair 90100

1,795. Base Price. Part no.: CLIENT MEASUREMENTS. Town: Postal code: Town: Postal code: Tel: Fax: Tel: Fax: Purchase order:

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

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required MVMA053 MVMA056. MVMA058 English Manual (STD) Dutch Manual

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

4.8. A6MA085 Italian Manual. 3" caster 4" caster. 8" caster Stem bolt Length. + 2,54 cm 1" + 5,08cm 2" STD. 36,8cm 14,5" 34,3cm 13,5" 39,4cm 15,5"

QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective January 2018

APEX 4.7. FRONT Seat-to-floor height ORDER FORM - USA. Height available +- 1/4" Caster sizes. 3" Caster 14" to 21" Specify desired height:

PAGE 2 BREEZY ELEGANCE

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

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.

C2 FRONT Seat-to-floor Height - Please select your choice. Custom Technologies Limited. 40 Raywood Crescent TAUPO. New Zealand

4.8. Name: K0005. Stem bolt Length /2 15 1/2 16 1/ /2 15 1/2 16 1/ /2 16 1/2 17 1/2

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS STABLE

BREEZY EC WHEELCHAIRS. The best combination of durability, selection and value.

IT S NOT IMAGINARY. IT S REALITY. BRINGING YOU LITTLE WAVE.

- 5 - New Style Frame (Beginning Serial Number QBZM From )

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.

USA Parts List FUZE T50

Kids Quickie 2 SE January 2018 EIZ10

Quickie LXI/LX. January 2019 EILXI/EILX. Address: Ship To City: o Fax o

MOVE ORDER FORM - CANADA

LIGHTWEIGHT FOLDING & SUPERIOR PERFORMANCE

Helio A6 ORDER FORM - CANADA

Transcription:

Quickie 2 October 2018 EIQ2X 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 E-Mail: Ship To City: PV: PC: Confirm Via: Fax E-Mail Ship To Phone: ( ) Fax: ( ) Option # Definition Price Option # Definition Price 1. FRAME Base model 002WM32 Quickie 2 $2,995.00 Transit Option N/A on Stroller Handles (Removable Push Handles) or Xtender 002TO46 Transit System WC19 002RS1 002RS2 002RS3 Rear Frame Type (300 lbs. Weight Capacity) Rear Side Frame Straight Rear Side Frame Rounded Depth Adjustable Back (DAB) N/A w/ swing-away, flip-back armrests. Backrest set 2" rear of seat tube w/ 1" adjustable forward. $340.00 002FS31 002FS30 Frame Style Standard Swing Away Hemi Swing Away 002HV1 Heavy Duty Package (350 lbs. weight capacity) Heavy Duty (18"-22" Wide only) N/A w/ Xtender. Includes Reinforced Back Upholstery & Stabilizer Bar. $1,165.00 2. SIZE / SEATING Frame Width Frame Depth 002W3 12" Seat Depth can be ordered up to 3" smaller for growth.std & HD frame available with 13"-20" 002W4 13" frame Depth. Hemi available 16-18 & 20 frame depth. Please refer to matrix in page 8 of 002W5 14" Appendix for frame Depth Vs seat Depth matrix. Growth is achieved to the front of the depth. 002W6 15" 002FD4 13" 002W7 16" 002FD5 14" 002W8 17" 002FD6 15" 002W9 18" 002FD7 16" 002W10 19" $284.00 002FD8 17" 002W11 20" $284.00 002FD9 18" 002W12 21" (Only Avail. w/ Heavy Duty) $284.00 002FD10 19" Steel reinforced 002W13 22" (Only Avail. w/ Heavy Duty) $284.00 002FD36 20" Steel reinforced Seat Depth Seat Sling 12" seat depth not available with Hemi frame 002SL1 Standard Seat Sling 002SD5 12" 002SL6 Omit Seat Sling ($21.00) 002SD6 13" JAY Cushions (Optional) 002SD7 14" To order any JAY cushions on-chair, please see the JAY price list. 002SD8 15" Cushion name or part number must be filled out with desired width and depth 002SD9 16" JAY Bundled Cushion 002SD10 17" 002JC20 Cushion Name or Part # Price List 002SD11 002SD72 18" 19" $284.00 Width: Depth: Cushion 002SD13 20" $284.00 002CU1 2" Cushion $173.00 Customer Service: (800) 263-3390 Fax: (800) 561-5834 Email: cscanada@sunmed.com www.sunrisemedical.ca Page 1 of 11

3. CASTERS / SEAT HEIGHT Front Seat Height Caster Fork Please see matrix on Page 9 for additional information. 13.5"-14" Hemi only Please see matrix on Page 9 for additional information. Frog Legs not 21.5"-22" not available in Hemi Frame available with Integral caster housing Caster Wheels Integral caster housing only Integral caster housing only All 8" casters N/A w/ 90 hangers or 13"-14" frame depth. (0-100 lbs) See matrix on page 9. (101-190 lbs) (191-265 lbs) N/A w/ HD package Caster Options (N/A w/8"x2") NA w/ Xtender, Frog Legs or Transit Standard N/A w/ Frog Legs Multi Position integral Caster Housing Multi Position Single side Caster Housing Integral bearing forks only available with Integral caster housing N/A with caster Pin locks Frog Leg

4. REAR WHEELS / SEAT HEIGHT Rear Seat Height Rear Wheel Type Not applicable w/ Xtender Power Assist Option. Ultra Lightweight Wheels only available w/ Alum Anodized Handrim. Handrims cannot be omitted on Lite Spoke Wheels.* Omit Rear wheel will default chair configuration set up to a 24" wheel Axle Plate N/A w/ Padded Armrest Axle Mountain Wheel only One Arm Drive N/A w/ Xtender, 12", 21" & 22" wide, HD package, amputee axle plates, and small tray table. N/A w/ combination of Padded SA arms and Anti tips. Only available w/ 20", 22", 24" mag wheels. Only available in 6 spoke Mags Xtender Power Assist RSH of 14.5"-20" for 22" rear wheels and RSH 15.5"-21" for 24" wheels. Front seat height must be greater than rear. N/A HD Package or Transit Option.Dual Drive mode available with B4ME. Max weight capacity of 265 lbs Xtender Power Assist Rear Wheel Tire NICKEL LITHIUM NICKEL Only available on 24" Mountain Rear Wheel LITHIUM Please select one of the following handrim options Xtender - Other Options Xtender Wheel Options

4. REAR WHEELS / SEAT HEIGHT (CONT) Rear Seat Height Availability Matrices Rear tire, side frame, and axle plate selections dictate seat height availability. Not all combinations are possible within acceptable seat height ranges Handrim Natural Fits available in 22", 24", and 25". Handrim selection N/A w/ Xtender. Ultra lightweight wheels only available w/ alum anodized handrim. Plastic coated limited to certain rims and sizes. Natural Fit w/ 5 spoke MAG only available in 24" - N/A on every rim Std Adj Available on 24" & 25" Spinergy LX wheel Option may not be available on all wheels N/A w/ Xtender. Only available with 24" or 26 " 6 spoke Mag or Lite Spoke rims. Camber (All in one) (default) Center of Gravity Preset Amputee Axle Plate will come preset at 1.0 Center of Gravity (CG), range od adjustment is -3.0 to -1.75 and 1.0 to 3.5 CG. (default) One Arm Drive CG 5. WHEEL LOCKS Wheel Lock Ergo & compact N/A w/ 13"-14" frame depth or amputee axle plate. Additional No Gos may exist depending on wheel size and position Wheel Lock Option Extension Handle N/A w/ ergo scissor or compact wheel locks Grade Aid Only available w/ high mount push or pull to lock wheel locks on pneumatic or pneumatic w/ airless tire options

Hangers Front mount hangers only available w/ aluminum angle adj footplates. ALR/ELR Hangers N/A w/ Push To Lock wheel locks. 6. HANGER & FOOTREST Lower Leg Length Setting (Extension Mount Only) Recommend 2" less than FSTFH. (*)denotes frame, 9" & 9.5" Hemi Only N/A w/ Platform Flip Up and Alum Angle Adj Front Mount footplates, 14"-22" width Std. Only N/A w/ Platform Flip Up and Alum Angle Adj Front Mount footplates, 14"-22" width Only available w/ front mount alum angle adj footplates and 14"-22" width Z-finity Hangers/Footrest System (Maximum weight capacity for Z-Finity footrests is 165 lbs) Some interference may exist in certain configurations. N/A with Heavy Duty Footplates Heel loop or leg strap not included, See Footplate Options Section (13"-22"w) (16"-22"w) (12"-22"w) (12"-22"w) (14"-22"w) vailable w/ Ext Mount ELR or ALR (12"-22"w) N/A w/ Hemi Hangers,ELR/ALR,Front Mnt Z-finity Footrest Mount Z-finity Footrest Pivot Arm Z-finity Footplate Some interference may exist in certain configurations. (Pair) Footplate Options (Ext Tube & Front Mount) Footrest Extension Tubes Required w/ extension tube mounted hangers. See leg length matrix Z-finity ExtensionTube Length (When Choosing Ext. Tube Mount) N/A w/ one-arm drive option or ELR/ALR or 90 front mount. Only available w/angle adj footplates N/A w/ 6", 7" or 8" casters with 90 hangers, or ELR's N/A w/6", 7" or 8" casters w/ 90 hangers or ELR/ALR

7. BACKREST / SEATING Back Type Backrest Upholstery (Standard or Angle Adjustable) Std EXO upholstery and Tension adj binding is always black. Ballistic Nylon, (3-5" Pivot) (5"-7" Pivot) 3DX & EXO Tension Adj Uph N/A with Heavy Duty. Max back height 20" for EXO. (Required with DAB) Back Type - Build 4 Me Options (19") (18"-23") (19") (22") (25") Must choose DAB Back type with B4ME options (19"-26") (22") N/A on Heavy Duty Back Post Options Standard Backrest Option Omit push handles N/A w/ stabilizer bar Standard Back type options: Med or Tall only. N/A w/ Angle Adjustable Backrest (N/A w/hd) Only avail w/ Std Back Upholstery. Std w/hd package (N/A w/hd) Med or Tall only Angle Adjustable Backrest Pivot Height Standard push handles only. Some interference w/ Padded SA arms. N/A w/ flipback or flip-back height adjustable armrests (classic). N/A w/angle Adj Back & Heavy D. Angle Adj Back type options: N/A w/hd Preset Angle Adjustable Backrest (-15 to +3 ) (Optional) Back Height (Std or Angle Adjustable) Back Height Setting (Std or Angle Adjustable) Angle Adjustable Backrest Chart EXO upholstery not available with 21" back height Back Tube Height Low Medium (*)20" & 21" only w/ Ang Adj Back Stroller Handles (Removable Push Handles) Only available w/ omit push handles. N/A w/ DAB, amputee axle plate, push handles, or when angle adjustable back is selected, flip-back or flip-back height adjustable armrests, and JAY backs. 15 3 REFER TO CHART IN DETERMINING PUSH HANDLE LENGTH PSIS Stabilizer Bar N/A with Folding Push Handle, or with Ht. Adj. Back or DAB Stroller handles A SEATING SURFACE CUSHION THICKNESS B Standard with HeavyDuty Package and Recline REGULAR 3 5 TALL 5 7 TO DETERMINE THE PROPER PIVOT-POINT HEIGHT, MEASURE BETWEEN THE PSIS AND THE TOP OF THE SEATING SURFACE (A), TH EN ADD THE THIICKNESS OF THE CUSHION (B) IF ONE IS USED. IF A DROP-SEAT FALLS BELOW THE SEAT RAILS, SUBTRACT THIS DISTAE FROM THE OVERALL VALUE. Tall

7. BACKREST / SEATING (cont) DAB Back Height Military Service Patches (Optional) N/A with standard Upholstery DAB Back Post Options Diagram of DAB in Appendix on page 9. SA Stroller Handle height range is 21.25"-28.5" DAB Backrest options JAY Back (Optional) (See J3 Order Form) 8. ARMREST / SIDE GUARDS Padded Swing Away Height Adjustable N/A w/ DAB, Amputee axle. Some limitations may exist with integral push handles, some RSTFHs and wheel sizes. **Now available w/transit. Setting Omit Armrest Flip Back N/A w/ DAB, Xtender, 12" - 14" frame depth, amputee axle, Classic Style armpad in highest/lowest axle RSH on rounded rear frame, or angle adjustable back. 4 Point (FS) J3 mounting bracket will cause interference with Flip Back Height Adj armrest (Classic 8.5"-13.5") (incl. Desk Length Pad) Armpad for Height Adjustable Ergo armpad only available with Single post Height adj & Flip back armrest Ergo not available with Classic Flip Back armrest (LITE 8.5"-13.5") Flip Up (For use with Depth Adjustable Back) (Flip Up armrests) (Flip Up armrests) Requires an Armpad or Foam from the Arm Pad section below Side Guard (Std. w/ foam) Plastic side guards N/A w/ height adj. arms. Side guard interference w/ Padded SA arms at some heights may exist. 9. KEY OPTIONS & ACCESSORIES Anti-Tip ( w/ Xtender) Additional Cover & Pack Accessories Backpack Positioning Belts Seat Pouch Tray Tables Spoke Guards Only available w/mountain, and Lite Spoke wheels, Not available with 5 spoke MAG wheels or Projection handrims 196K1 196K2 196K7 JAY Positioning JAY Lower Extremity S/A Support Left Right Position Omit Hanger Left Right Pad Size 6" x 8" 8" x 10" $295.00 ($16.00)

9. KEY OPTIONS & ACCESSORIES (cont) Miscellaneous O2 holder N/A with Xtender in 12" - 13" frame width. Crutch holder N/A with EXO Tension Adj upholstery and Omit push handle (N/A w/ front mount hangers) Standard Frame Colors (Not avail as base w/zebra) 10. COLOR Matte Frame Colors Custom Frame Color (Choose above base color) Std with White unless above base paint is chosen N/A w/ Black Additional Options Through Built for Me To inquire about any unique customization for Quickie products, contact: Phone: (800) 263-3390, Fax: (800) 561-5834 Commonly Requested Options Include: Up to 24" wide Custom Anodizing Dual Mount Wheel Locks - Attendant Foot Lock Hub Wheel Locks on Mag or Spoke Wheels Colored handrims Frame Depth matrix 11. APPENDIX Depth Adjusable Back Frame SEAT DEPTH FRAME DEPTH SLING DEPTH.05 SEAT SLING TO PUSH HANDLE MEASUREMENT BACKREST MOUNTING HARDWARE WILL AFFECT SEAT DEPTH

11. APPENDIX Lower Leg Length Matrix 2" & 4" extensions for front mount hangers shipped separate, not mounted. Front seat height must be at least 2" taller than lower leg length on all swing in/out hangers. Front seat height must be at least 2" taller than maximum lower leg length on all front mount hangers. All values shown apply to Standard frame style, subtract 1.5" to get Hemi equivalent. More than 2" will require on eld adjustment. Backrest Height Matrix

11. APPENDIX Quickie 2 Seat To Floor Height Matrix - Standard Frame *Hemi options will result in a reduction of approx 2 1/2" * Values Given are Estimates. Actual seat to floor height may vary based on seat depth and front seat to floor height selection.

11. APPENDIX Quickie 2 Seat To Floor Height Matrix - Standard Frame *Hemi options will result in a reduction of approx 2 1/2" * Values Given are Estimates. Actual seat to floor height may vary based on seat depth and front seat to floor height selection.