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

Similar documents
NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS

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

NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS

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.

AADL #W643 NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

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

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

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.

Parts Catalog Issued: Nov 10, 2006

18 Wide. MRI Transport Wheelchairs. Overall Width: 26 Wheelchair, With Fixed Footrest. Specifications:

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

Parts Catalog Issued: Mar 12, Comet Rocket. Wheelchairs

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.

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

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.

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

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

USA Parts List BENTLEY

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

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.

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

Spare Parts Catalogue. Version: 2014/10/08b EN

USA Parts List FUZE T20

USA Parts List FUZE T50

Table of Contents. Tilt Wheelchair. Folding Wheelchair. power Wheelchair. commodes. At Power Plus Mobility, We care!

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

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

BEARINGS BEARINGS

Parts Catalog Issued: Apr 11, Crossfire T6A. Wheelchair

CareGuard by Invacare

MVP / MVP jr. (After 10/15/01) Xtra (After 8/31/04)

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

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

Standard Base Price: 618

Parts Catalog Issued: Apr 11, Crossfire T7A. Adjustable Rigid Wheelchair

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

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

W H E E L C H A I R S

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

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

Standard Base Price: 539

MOVE ORDER FORM - CANADA

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

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.

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

MASS Script Form. Frame. Backrest. Seat Depth

Parts Catalog Issued: Aug 1, Patriot. Wheelchair

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

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

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) PRO-CG. Adult Manual Wheelchair

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

NXT Pediatric. Manual Wheelchair. Transport Optional Base

Top End Crossfire T7A Ultra Lightweight AADL Customers Only Active Performance Adjustable Rigid Wheelchair AADL # W149

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

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

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

Parts Catalog Issued: Mar 26, Xterra GT. Power Wheelchair

Parts Catalog Issued: Apr 11, A-4 A-4 Titanium. (Wheelchairs Built After 9/15/02)

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

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

Quickie QX December 2018

Company Name Account # Phone # P.O.# Date FRAME SELECTIONS DEPTH

Quickie QX July 2017

Invacare A4 Ultralight Active Performance Rigid

Account Number: Provider Name: Contact:

SIDEFRAME AND CROSSBRACE... 3 ARM: FLIP-BACK FIXED-HEIGHT... 4 ARM: FLIP-BACK ADJUSTABLE-HEIGHT... 4 REAR WHEEL... 5 CASTER... 5

For upholstery and frame color availability, please refer to the corresponding wheelchair price list.

Transformer. Rev C. Aug 15, 2010 Page 1 of 8

GLYDER PARTS CATALOGUE PLEASE TRY TO PROVIDE AS MUCH DETAIL AS POSSIBLE WHEN ORDERING PARTS THANK YOU FOR YOUR BUSINESS

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

Account Number: Provider Name: Contact:

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

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

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

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

Parts Catalog Issued: Jan 8, Orbit. Wheelchair

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

Adjustable Height Raised Toilet Seat Model 101 RTS Pricelist/Order Form December 2014

Transport Chairs / Walkers MRI Transport

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

Invacare A4 Titanium Ultralightweight Active Performance Rigid

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

discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed

TILT COMMODE September 16, 2011

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

For AADL Only AADL Cat. #W558

champion carbon Customer weight = Kg Code X Description Dealer SEATING CHOICE DDF0204 küschall Champion Carbon 85 Frame Angle

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

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

Parts Catalog Issued: Apr 11, Power Tiger. Wheelchair

Quickie IRIS January 2014

Freedom NXT Folding Tilt-in-Space Wheelchair AADL Customers Only AADL # W684 Effective October 1st, 2018

2004 Medicare Billing Guidelines for Rehab Products

Invacare. Family Compatibility Portfolio Optimize your business with an all-in-one solution. Jan

SEATING CHOICE TITANIUM FRONT FRAME

Pronto M50 Pronto M51 with SureStep (Before 1/20/05)

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

Transcription:

TRACER EX2 FOLDING WHEELCHAIRS Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018 PROVIDER NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS Invacare Canada Customer Service Email: CanadaOrders@invacare.com Toll Free Phone: 1(800)668-5324 Toll Free Fax: 1(800)668-5478 TREX2_WCS16 TREX2_WCS18 16 x 16 Frame $798 Removable Fixed Height, Full Length Arms 18 x 16 Frame $798 Removable Fixed Height, Full Length Arms TREX2_WCS20 20 x 16 Frame $698 Model Pictured: TREX2_WCS16 Full Length Permanent Arms ACCESSORIES Frame Finish Silver Vein 1360 Adjustable Anti-Tippers $109 STF Height 17.5" or 19.5" Seat To Floor Height - Set at 17.5" 1329BKST 8" Wheel Lock Extensions $63 Back Height 16" Fixed 1335ST Non-Folding Device (14-22"W Only) $63 Back Type Dual Embossed Black Vinyl Upholstery 1514 Overhead Anti-Theft Device (16-18" W Only) $75 Seat Type Dual Embossed Black Vinyl Upholstery w/ Heavy Duty Liner 1121288 Single Pole Anti-Theft Device $106 Casters 8 x 1 Solid Rubber Casters w/ Dual Sealed Bearings 1515ST Push Button Seat Positioning Strap $84 Rear Wheels 24" Composite w/ Urethane Tires 1496 IV/Oxygen Cylinder Holder Package $198 Handrims Black Composite 1497 Oxygen Cylinder Holder Package $198 Wheel Locks Push to Lock 1820ST Non-Removable Device for Front Riggings $41 TRACER SX5 FOLDING WHEELCHAIRS TRACER SX5 - Black Upholstery TRSX5_WCH16 TRSX5_WCH18 16 x 16 Frame $1,280 18 x 16 Frame $1,280 TRSX5_WCH20 20 x 16 Frame $1,430 Model Pictured: TRSX5_WCH18 Weight Cap. 300 lbs. 8" x 1.75" Semi-Pneumatic Casters Frame Finish Silver Vein STF Height 17.5" or 19.5" Seat To Floor Height - Set at 17.5" ACCESSORIES Arm Type Full Adjustable Height Flip Back 1360 Adjustable Anti-Tippers $109 Back Height 18" Fixed 1329BKST 8" Wheel Lock Extensions $63 Back Type Dual Embossed Black Vinyl Upholstery 1335ST Non-Folding Device (14-22"W Only) $63 Seat Type Dual Embossed Black Vinyl Upholstery w/ Heavy Duty Liner 1514 Overhead Anti-Theft Device (16-18" W Only) $75 Casters 8" w/ Dual Sealed Caster Bearings 1121288 Single Pole Anti-Theft Device $106 Rear Wheels 24" Composite w/ Treaded Urethane Tires 1515ST Push Button Seat Positioning Strap $84 Handrims Black Anodized Handrims 1496 IV/Oxygen Cylinder Holder Package $198 Wheel Locks Push to Lock w/ Extensions 1497 Oxygen Cylinder Holder Package $198 Footrests 1820ST Non-Removable Device for Front Riggings $41 Accessories Push Button Style Seat Positioning Strap Adjustable For the most current pricing information visit www.invacare.ca Page 1 / 5

TRACER SX5 FOLDING WHEELCHAIRS TRACER SX5 - Blue Upholstery TRSX5_CCAC2 TRSX5_CCAC3 16 x 16 Frame $1,280 Hemi Swingaway Footrests w/ Composite Footplates 18 x 18 Frame (incl. 2" extension) $1,425 Hemi Swingaway Footrests w/ Composite Footplates TRSX5_CCAC1 20 x 18 Frame (incl. 2" extension) $1,575 Model Pictured: TRSX5_CCAC3 Weight Cap. 300 lbs. 8" x 1.75" Semi-Pneumatic Casters Frame Finish Silver Vein STF Height 17.5" or 19.5" Seat To Floor Height - Set at 17.5" ACCESSORIES Arm Type Full Adjustable Height Flip Back Arms 1360 Adjustable Anti-Tippers $109 Back Height 18" Fixed Back Height 1329BKST 8" Wheel Lock Extensions $63 Back Type Dual Embossed Blue Vinyl Upholstery 1335ST Non-Folding Device (14-22"W Only) $63 Seat Type Dual Embossed Blue Upholstery w/ Heavy Duty Liner 1514 Overhead Anti-Theft Device (16-18" W Only) $75 Casters 8" w/ Dual Sealed Caster Bearings 1121288 Single Pole Anti-Theft Device $106 Rear Wheels 24" Composite w/ Corded Tires 1515ST Push Button Seat Positioning Strap $84 Handrims Black Anodized Handrims 1496 IV/Oxygen Cylinder Holder Package $198 Wheel Locks Pull to Lock 1497 Oxygen Cylinder Holder Package $198 Accessories Push Button Style Seat Positioning Strap 1820ST Non-Removable Device for Front Riggings $41 TRACER IV HEAVY DUTY FOLDING WHEELCHAIRS T4_WCB22 22 x 18 Frame $2,460 Model Pictured: T4_WCB22 T4_WCB24 24 x 18 Frame $2,460 Weight Cap. 450 lbs. Frame Finish Silver Vein ACCESSORIES STF Height 17.5" or 19.5" Seat To Floor Height - Set at 19.5" 1360 Adjustable Anti-Tippers $109 Arm Type Full Adjustable Height Flip Back Arms 1329BKST 8" Wheel Lock Extensions $63 Back Height 16" Fixed Back Height 1335ST Non-Folding Device (14-22"W Only) $63 Back Type Dual Embossed Black Vinyl Upholstery 1121288 Single Pole Anti-Theft Device $106 Seat Type Dual Embossed Black Vinyl Upholstery w/ Heavy Duty Liner 1515ST Push Button Seat Positioning Strap $84 Casters 8" x 1.75" Semi-Pneumatic Casters 1496 IV/Oxygen Cylinder Holder Package $198 Rear Wheels 24" HD Composite Wheels w/ Pneumatic Flat Free Inserts 1497 Oxygen Cylinder Holder Package $198 Handrims Black Handrims 1820ST Non-Removable Device for Front Riggings $41 Wheel Locks Push to Lock Wheel Locks w/ Extensions Footrests Accessories: Push Button Style Seat Positioning Strap For the most current pricing information visit www.invacare.ca Page 2 / 5

MYON LIGHTWEIGHT FOLDING WHEELCHAIRS MYON - Fixed Depth and Back Models Weight Cap. 275 lbs. Frame Finish Wet Black Frame Type Fixed Depth Frame Casters 6" Composite Urethane 3 Spoke Casters Back Canes 2 Position, 16"-17" Height w/ 7 Bend and Rigidizer Bar Back Type Tension Adjustable Nylon, Padded Seat Type Nylon w/ Hook and Loop Arm Type Flip Back, Adjustable Height, Full Handrims Aluminum Anodized Wheel Locks Push To Lock w/ Extensions Rear Wheels 22" Composite Urethane Axles Quick Release Model Pictured: MYON_WCL18 Axle Position Stable (Behind Back Cane) Footrests 70 Swing In/Out with Quad Release Mechanism Footplates Flip Up Composite Accessories: Heel Loops MYON_WCL16 16 x 16 Frame, 16" STF $2,308 Push Button Style Seat Positioning Strap MYON_WCL18 18 x 16 Frame, 19" STF $2,308 MYON_WCL20 20 x 16 Frame, 19" STF $2,308 MYON - Adjustable Depth and Back Models Model Pictured: MYON_JIT7 MYON_JIT1 MYON_JIT2 MYON_JIT3 MYON_JIT4 MYON_JIT5 16x16, 15" STF $2,359 5" Composite Urethane Casters 20" Composite Urethane Wheels 16x16, 17" STF $2,359 16x18, 17" STF $2,359 18x16, 15" STF $2,359 5" Composite Urethane Casters 20" Composite Urethane Wheels 18x16, 17" STF $2,359 MYON_JIT6 18x18, 15" STF $2,359 Weight Cap. 275 lbs. 5" Composite Urethane Casters Frame Finish Wet Black 20" Composite Urethane Wheels Frame Type Adjustable 16-18 in Seat Depth Range Back Canes Adjustable Angle, 14"-18" w/ 7 Bend and Rigidizer Bar MYON_JIT7 18x18, 17" STF $2,359 Back Type Tension Adjustable Nylon, Padded Seat Type Nylon w/ Hook and Loop Arm Type Flip Back, Adjustable Height, Full Wheel Locks Push To Lock w/ Extensions MYON_JIT8 20x16, 15" STF $2,359 Handrims Aluminum Anodized 5" Composite Urethane Casters Axles Quick Release 20" Composite Urethane Wheels Axle Position Active (In Front Of Back Cane) Footrests 70 Swing In/Out with Quad Release Mechanism MYON_JIT9 20x18, 15" STF $2,359 Footplates Flip Up, Angle and Depth Adjustable 5" Composite Urethane Casters Accessories: Heel Loops 20" Composite Urethane Wheels MYON_JIT10 20x18, 17" STF $2,359 For the most current pricing information visit www.invacare.ca Page 3 / 5

CONCEPT 45 MANUAL TILT WHEELCHAIRS 1 2 3 4 Note: Back and cushion sold separately. 1. Comfort Headrest with Adjustable Multi Axis Hardware 2. Adjustable Angle back canes & 45 Degrees of Tilt 3. Adjustable Height Full Length Arm Supports 4. Push Wheel Locks with 6 Extensions Frame Finish Wet Black Tilt MechanismTraditional Hand Release CT45_JIT1 16 x 18 Frame, 18" STF $3,374 Back Height 22" 22" Solid Urethane Rear Wheels, 7" Urethane Casters Back Canes Adjustable Angle Seat Pan ABS CT45_JIT2 18 x 18 Frame, 18" STF $3,374 Arm Type Full, Adjustable Height Arms 22" Solid Urethane Rear Wheels, 7" Urethane Casters Casters 7" Urethane Rear Wheels Solid Urethane CT45_JIT3 20 x 18 Frame, 18" STF $3,374 Handrims Black Aluminum Handrims 22" Solid Urethane Rear Wheels, 7" Urethane Casters Axles Permanent Axles Wheel Locks Push to Lock w/ 6" Extensions CT45_JIT4 16 x 18 Frame, 14.5" STF $3,374 Footrests 70 Swingaway Non-Tapered Sector Style w/ Medium Slide Tubes Footplates Adj Angle Flip-Up Footplates Accessories Comfort Headrest w/ Adjustable Multi Axis Mounting Hardware CT45_JIT5 18 x 18 Frame, 14.5" STF $3,374 Heel Loop w/ Ankle Strap One Piece Padded Leg Strap Anti Tippers CT45_JIT6 20 x 18 Frame, 14.5" STF $3,374 Lower Frame Impact Guards For the most current pricing information visit www.invacare.ca Page 4 / 5

SOLARA 3G TILT-IN-SPACE WHEELCHAIRS Model Pictured: SLTD3G4 SLTD3G1 18 x 18 Frame, 14.5" STF $5,442 16"-20" Seat Width Range 15"-19" Seat Depth Range 18" Composite Wheels Pneumatic Tires 20" Straight Back Canes 60 Degree Swingaway Sector Block Style Footrests SLTD3G2 18 x 18 Frame, 16" STF $5,442 16"-20" Seat Width Range Weight Cap. 300 lbs. 15"-19" Seat Depth Range Frame Finish Wet Black 22 in Composite Wheels Frame Type Transport Brackets Urethane Treaded Tires Tilt MechanismTraditional Hand Release 20" Back Canes w/ Bend Tilt Options Tilt Lock Out Collars 70 Degree Swingaway Sector Block Style Footrests Tilt Trigger Lock Out Levers Back Height 20" SLTD3G3 18 x 18 Frame, 16.5" STF $5,442 Back Canes Non Folding Aluminum Back Canes 16-20 in Seat Width Range Stroller HandleAdj Angle Stroller Handle - Inside Mount 15-19 in Seat Depth Range Seat Pan Flush Mounted 20 in Composite Wheels Arm Height Low Urethane Treaded Tires Arm Type Two-Point Flip-Back Adjustable Height Full 20" Back Canes w/ Bend Casters 6 In x 1 In Endura Roll Caster (Urethane) 70 Degree Swingaway Sector Block Style Footrests Axles Quick Release Handrims Aluminum Anodized SLTD3G4 20 x 18 Frame, 16.5" STF $5,442 Wheel Locks 6" Bolt-on Wheel Locks 18-22 in Seat Width Range Footrests Standard Front Rigging Mount 18-22 in Seat Depth Range Footplates Adj Angle Flip-Up Footplates 22 in Composite Wheels Accessories Rear Anti-tippers Urethane Treaded Tires Calf / Leg Strap 20" Back Canes w/ Bend ChairArmor Black Neoprene Frame Protectors 70 Degree Swingaway Sector Block Style Footrests Heel Loops For the most current pricing information visit www.invacare.ca Page 5 / 5