Quickie Q7 Adjustable SUBMIT January 2018 EIR4 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: Dealer Phne: ( ST: Address: ZIP: Fax: ( Address: Cnfirmatin Email: Cnfirm Via: Ship T City: Fax ST: Ship T Phne: ( Email ZIP: Fax: ( 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. a Optin # HCPCS Definitin Price a Optin # HCPCS Definitin Price 1. FRAME STYLE & SETUP Base Mdel Fr sizes 14" r less please use HCPCS E1235 186WM60 K0005 Quickie Q7 - Adjustable $2,625.00 Weight capacity 265 lbs Perfrmance Package (N substitutins, discunt given n separate line 186QD01 Single Sided Frk Ultra Lightweight Wheel Schwalbe Marathn Plus Evlutin Cmpact Wheel Lck Retail Value $625.00 Package Price $535.00 Ultra Lite Package (N substitutins, discunt given n separate line 186QD02 Ultra Lite Seat Sling Ultra Lightweight Wheel Schwalbe Speed Run Tire Cmpact Wheel Lck Retail Value Package Price $100.00 $600.00 $510.00 Transit 186TO45 K0108 Transit Frame Angle See FIGURE 1 Measure frm frnt frame t flr. 186FA1 75 186FA8 80 186FA2 85 Frame Inset Per Side See FIGURE 2 Frame Inset is the distance frm the utside f the seat tube t the utside f the ftrest. 186FF1 0" 186FF2 1" (N/A w/ 12" wide 186FF3 2" (N/A with 12" & 13" wide Frame Style See FIGURE 3 Measurement fr set up. 186FS9 Standard 186FS34 Classic * Standard Frame - Seat Sling t frnt frame bend angle is 1.5" shrter than the classic psitin. Classic Frame - Traditinal seat sling t frnt frame bend angle dimensins. Frnt f back cane pst t frnt edge f seat sling will remain the same fr bth Standard and Classic. $320.00 Caster Husing Psitin See FIGURE 4 Attitude Bike (Optinal 186IN04 See Order Frm Attitude Bike bundle Figure 1 Figure 2 186LH01 186LH02 186LH03 1 Suggested fr 3" & 4" casters. Fr 2" Inset N/A w/ setting 1 2 Suggested fr 5" & 6" casters. 3 N/A w/ 6" casters Figure 3 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Page 1 Figure 4
1. FRAME STYLE & SETUP (CONT. Frame - Direct Munt Wheel Lck (Optinal Seat Depth N munting clamp hardware. Only available with Cmpact Wheel Lck and 0 Camber. Nt available with muntain tires r rear suspensin. Traditinal wheel lcks available, see page 5. N/A with rear suspensin system. 186WH13 Direct Munt Wheel Lck Depth Adjustable Backrest (Optinal See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. 186DP02 186DP03 186DP04 0 Backrest at standard psitin, field adjustable t -1" r -2" See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 186SD5 186SD6 186SD7 186SD8 186SD9 12" 13" 14" 15" 16" Figure 6 186SD10 186SD11 186SD12 186SD13 17" 18" 19" 20" (E2203 $550.00 Figure 7 $165.00-1 Backrest -1" ffset, field adjustable t flush r -2" $165.00-2 Backrest -2" ffset, field adjustable t flush r -1" $165.00 Figure 5 186OP01 Seating Systems Standard Seat Sling Ultra Seat Sling 186OP02 Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. 186OP04 Omit Seat Sling $100.00 Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 186S4 186S5 186S6 186S7 12" 13" 14" 15" 16" 186S8 186S9 186S10 186S48 17" 18" 19" 20" (E2201 $500.00 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 186JC20 Cushin Name r Part # Price List Width: Depth: 2. FRONT SEAT HEIGHT SET UP Frnt Seat Height See FIGURE 8 Measure frm the frnt f the seat rail t the flr. 186SH14 16.0" 186SH20 186SH15 16.5" 186SH21 186SH16 17.0" 186SH23 186SH17 17.5" 186SH24 186SH18 18.0" 186SH26 186SH27 Figure 8 18.5" 19.0" 19.5" 20.0" 20.5" 21.0" 186CW1 186CW3 186CW31 186CW72 186CW44 186CW64 186CW5 186CW51 186CW6 186CW65 186CW7 186CW66 186CW34 186CW33 186CW35 186CW68 Caster Wheels 3" Micr 4" Lw Prfile Plyurethane 4" Micr Lighted 4" x 1" Aluminum Ply E2219 4" x 1.25 Semi Pneumatic 4" x 1.5" Aluminum Sft Rll 5" Lw Prfile Plyurethane 5" Micr Lighted E2219 5" Sft Rll (Grey -N/A w/frg Legs 5" x 1" Aluminum Ply E2219 5" x 1.5" Semi Pneumatic 5" x 1.5" Aluminum Sft Rll 6" Ply E2214 6" Pneumatic E2215 E2219 6" x 1.5" Semi Pneumatic 6" x 1.5" Aluminum Sft Rll 186CF65 186CF69 186CF53 186CF54 186CF55 Caster Frks and Suspensin Multiple Psitin Multiple Psitin Single Sided Frk E1015 Frg Legs 0 weight t 100 lbs. E1015 Frg Legs 101 lbs. weight t 190 lbs. E1015 Frg Legs 191 lbs. weight t 265 lbs. Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Page 2 $70.00 $110.00 $55.00 $185.00 $110.00 $195.00 $205.00 $150.00
3. FOOTPLATE OPTIONS Ftrest Angle Adjustable Flip Back N/A w/ 19-20 wide w/ 0 inset. Sme Flip back cnfiguratins wn't allw 2 " grund clearance and will need t raise up. Flip back nt available Caster setting 1" & 2" inset. 186F229 Aluminum Tubular 186F274 Aluminum Tubular w/ Snap On Cver $30.00 186F276 K0040 Angle Adjustable Flip Back $185.00 186F51 K0040 Platfrm Ftrest 186F111 K0040 Ultra Lite Platfrm Ftrest N/A w/ 14" wide and 2" inset, N/A w/ 19-20 wide w/ 0" inset $115.00 Adaptive Platfrm Spacer N/A with Aluminum Tubular r Ultra Lite Platfrm. Nw available with Angle Adj. Flip Back. 186AD1 186AD2 186AD3 186DI08 186DI03 186DI04 186DI05 186DI07 186DI02 186DI06 K0038 K0038 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer Ftrest Optins High Munt Ext Tubes (N/A w/ Tubular ftrest $55.00 Leg Strap $35.00 Extra Leg Strap $35.00 Gel Hanger Cver $105.00 Neprene Impact Guards Wear Pads $50.00 Psitin Plates (N/A fr Tubular Ftrest $50.00 4. BACKREST 186BT96 Flding Angle Adj w/duble Lck Dwn Back Type 186BT3 Nn-Flding Angle Adjustable 186B110 186B127 186B111 186B137 Chse Optin 1 r 2 1. Aluminum Height Adjustable Backrest 2. Ultra Lightweight Aluminum Fixed Backrest 10 "- 14" Back Height Select back height. 8", 9", r 10" nly available with mit push handles. 10 11 12 13 14 17", 18", r 19" nly available with fld dwn push handles 12 "- 16" Back Height 186BB21 8" 186BB17 14" 12 13 14 15 16 186BB20 9" 186BB18 15" 14 "- 18" Back Height 186BB13 10" 186BB19 16" 14 15 16 17 18 186BB14 11" 186BB10 17" 16 "- 20" Back Height 186BB15 12" 186BB11 18" 16 17 18 19 20 186BB16 13" 186BB12 19" Twel Bar Military Service Patches 186QT01 Standard Style - 4" Offset Only available n tensin adjustable uphlstery and Jay 3 Back 186QT02 Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with 19" & 20" wide $50.00 186VU1 186VU2 186VU3 186VU4 US Marines Patch US Army Patch US Navy Patch US Air Frce Patch Backrest Handles 186VU12 Cast Guard Patch 186PH6 Integral Push Handles 186VU5 Purple Heart Patch Fld Dwn Push Handles N/A w/ 10"- 186VU8 Purple Heart with Marines Patch 186PH5 14" adj height & 8"-10" fixed height $100.00 186VU9 Purple Heart with Army Patch N/A w/ standard uphlstery 186VU10 Purple Heart with Navy Patch 186PH2 Omit Push Handles 186VU11 186VU13 Purple Heart with Air Frce Patch Purple Heart with Cast Guard Patch Backrest Uphlstery 186BU1 Standard Uphlstery Backrest Optins 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $315.00 Telescping Push Handlles have Duble "D" tubing t eliminate rtatin. 186BU71 E2611 Backrest Tensin Adj 3DX Vented $330.00 Narrw Backrest Inset Backcanes 1" 186BU14 Omit Back Uphlstery -$15.00 narrwer than selected seat width. N/A with 186OD5 12" Wide. N/A w/ Aluminum r Carbn $80.00 JAY J3 Back Side Guards 186JB01 Telescping Push Handles Range f J3 Back T rder a J3 Back please 186A192 $215.00 13-19" frm sling t handle select Omit Back Uphlstery. See J3 Back Price List Order Frm fr Part #'s. Telescping Push Handles - Tall 186A195 $215.00 (25" frm seat t push handle Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Page 3
5. REAR SEAT HEIGHT SET UP Axle Plate Extended COG N/A w/ Xtender Pwer Assist Adjustable COG (1"-4" Adjustable Extended COG (0"-3" 4-Link Rear Suspensin COG (0"-3" Single Pst nly available up t 2" COG. Plastic Side Guards nly available up t 2.5" COG. N/A w/ Xtender 186SV08 186SV09 Weight frm 0 lbs t 175 lbs Weight frm 176 lbs. t 265 lbs $595.00 $595.00 RSH 16.5"-19" with 22" wheels, RSH 17.5"-20" with 24" wheels 0 camber, pneumatic tire. 22" & 24" wheels nly. Anti-Tips n charge. N/A w/ Transit and 4-link Suspensin. Dual Drive mde available with B4ME 186XT6 E0986 22" Xtender Pwer Assist JWX-2 NICKEL $7,895.00 186XT7 E0986 22" Xtender Pwer Assist JWX-2 LITHIUM $8,695.00 186XT4 E0986 24" Xtender Pwer Assist JWX-2 NICKEL $7,895.00 186XT5 E0986 24" Xtender Pwer Assist JWX-2 LITHIUM $8,695.00 Please select ne f the fllwing handrim ptins 186XH5 186XH6 Plastic Cated Stainless Steel Xtender - Other Optins 186XA10 186XA11 Spare NiMH Pwer Pack - NICKEL Spare Li-in Pwer Pack - LITHIUM $1,395.00 $1,795.00 186XA9 186XA4 E2213 E2213 Rear Suspensin (Optinal Xtender Pwer Assist Xtender Wheel Optins 186XA8 SPARE 22" Lite Spke Pneu Alum SPARE 22" Lite Spke Pneu Plastic SPARE 24" Lite Spke Pneu Plastic Center f Gravity Preset Measure frm frnt f back pst t the center f rear axle. Xtender 1" - 4" 186CC12 0" 186CC1 186CC2 186CC3 186CC4.5" 1.0" 1.5" 2.0" 186CC5 2.5" 186CC6 3.0" 186CC7 3.5" 186CC8 4.0" 186XA2 SPARE 24" Lite Spke Pneu Alum Wheel 5 Spke Ultra Mag Lite Spke Tire Mag Lt wt Spinergy Full Ply Tire 20,22,24 20,22,24 20,22,24 High Press. Clincher 22,24,25,26 22,24,25 22,24,25,26 SHOX Perfrm. Ply 20,22,24 24 24,25 24,25 Knbby V-TRAK 24 24 Pneumatic 20,22,24 20,22,24 20,22,24,26 22,24,26 Pneumatic w/airless Insert 20,22,24 20,22,24 20,22,24,26 22,24,26 Schwalbe Marathn 24,25,26 22,24,25 24,25,26 Schwalbe Speed Run 24,25 24,25 24,25 22" = 489 mm 24" = 540 mm 25" = 559 26" = 590 186CI1 186CI2 186CI4 Frnt t Rear Seat Height Matrix 12" Seat Depth 2.5" Max Frnt t Rear Seat Hgt. 13", 14" Seat Depth 3.0" Max Frnt t Rear Seat Hgt. 15", 16" Seat Depth 3.5" Max Frnt t Rear Seat Hgt. 17", 18" Seat Depth 4.0" Max Frnt t Rear Seat Hgt. 19", 20" Seat Depth 4.5" Max Frnt t Rear Seat Hgt. 186RH11 186RH12 186RH13 186RH14 186RH15 186RH16 186RH17 186RH18 186RH19 186RH26 186RH20 186RH27 186RH21 186RH37 186RH22 186AX1 186AX13 0 3 Camber 6º (N/A with Std Mag and 5 spk MAG Wheels Rear Seat Height 13.0" Only w/ 20" Rear Wheel. N/A w/ Rear Suspensin 13.5" Only w/ 20" Rear Wheel. N/A w/ Rear Suspensin 14.0" Only w/ 20" Rear Wheel. 14.5" Only w/ 20" Rear Wheel. 15.0" Only w/ 20" r 22" Rear Wheel fr Adjustable Axle. Only w/ 20" Rear Wheel fr Rear Suspensin 15.5" Only w/ 20" r 22" r 24" w/hp Clincher Rear Wheel. Only w/ 20" Rear Wheel fr Rear Suspensin 16.0" N/A w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 16.5" N/A w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 17.0" 17.5" 18.0" 18.5" 19.0" 19.5" 20.0" N/A w/ Rear Suspensin Axle Quick Release Steel Quad Quick Release Steel Only available with Std Mag Whls Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Cntact Built 4 Me fr Spinergy clr ptins r Tplin Carbn Wheels. 186RW3 20" Mag 186RW8 22" Mag 186RW1 24" Mag 186RW103 20" Mag Wheel 5 Spke 186RW104 22" Mag Wheel 5 Spke 186RW102 24" Mag Wheel 5 Spke 186RW90 20" Lite Spke $200.00 186RW91 22" Lite Spke $200.00 186RW92 24" Lite Spke 186RW93 25" Lite Spke 186RW94 26" Lite Spke $80.00 186RW06 22" Ultra Lightweight Spke 2.0 186RW10 24" Ultra Lightweight Spke 2.0 186RW16 25" Ultra Lightweight Spke 2.0 186RW28 22" Spinergy SPOX Black Spkes $820.00 186RW95 24" Spinergy SPOX Black Spkes $820.00 186RW96 25" Spinergy SPOX Black Spkes $820.00 186RW97 26" Spinergy SPOX Black Spkes $820.00 186RW32 22" Spinergy LX Black Spkes $1,025.00 186RW98 24" Spinergy LX Black Spkes $1,025.00 186RW99 25" Spinergy LX Black Spkes $1,025.00 186RW40 26" Spinergy LX Black Spkes $1,025.00 186RW50 24" Muntain Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Page 4
Rear Wheel Tire Handrim 186RT3 Full Ply Tire Natural Fit Handrims nly available in 22", 24", & 25". 186RT6 Natural Fit w/ 5 spke MAG nly available in 24" High-Pressure Clincher 186HR1 Aluminum Andized 186RT38 E2218 SHOX Perfrmance Ply Plastic Cated N/A w/ 25" & 26" 186HR4 Lite Spke Wheels 186RT27 Knbby V-TRAK by Kenda 186HR22 Natural Fit - Standard Grip $395.00 186HR23 Natural Fit - Super Grip 186RT12 Muntain Only available in 24" 186HR30 Natural Fit LT - Standard Grip $415.00 186HR31 Natural Fit LT - Super Grip $475.00 186RT1 Pneumatic Spinergy Flex Rim Only available n 186HR24 $650.00 Pneumatic Airless Insert Spinergy LX wheels 24" & 25" 186RT2 $80.00 E2213 N/A with Xtender Omit Handrim 186HR7 N/A w/ Ultra Lightweight Wheels 186RT21 Schwalbe Marathn Plus Evlutin $135.00 186RT28 Schwalbe Speed Run Tire 5. REAR SEAT HEIGHT SET UP (CONT 6. ARMREST Armrest - Padded Swing Away Sme limitatins when used with the Angle Adjustable Back in the rear mst setting Please select a setting, will default t 11" if n selectin is made. 186AA18 E0973 Padded Swing-Away STD (9" t 14" $210.00 9" 10" 11" 12" 13" 14" 186AM23 186AM21 186AM24 186AM22 Armpad - Fr Height Adjustable Desk Length (10" Classic Desk Length (10" Cntur Full Length (14" Classic Full Length (14" Cntur 186AA11 186AA29 E0973 E0973 Armrest - Height Adjustable Single Pst Height Adjustable - Std Range 8" - 13". Adjust in 1" increments Single Pst Height Adjustable - Lw Range 6.5" - 10.5". Adjust in 1" increments $285.00 $285.00 186NP01 Armrest Optins Gel Swing Away Pad $105.00 7. KEY OPTIONS & ACCESSORIES Wheel Lck Nt all wheel lcks available in all seat depths, wheel size, r COG 186WL1 High Munt Push 186WL2 High Munt Pull 186WL45 Erg Scissr 186WL30 Cmpact 186WL10 Omit Wheel Lck 186WL12 Wheel Lck Optins D Nt Munt Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 Black 186GE02 Matching Frame- Standard Clrs 186GE03 Matching Frame- Custm Clr $50.00 Psitining Belt 186A117 E0978 Belt 2" Aircraft Buckle w/clamps $110.00 186A118 E0978 Belt 2" Aircraft Buckle Padded w/clamps $120.00 186A141 E0978 Belt 1.5" Aut Buckle Universal w/clamps $70.00 Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks 186EH7 E0961 Extensin Handle (Pair E0971 Anti Tips Anti Tips (Pair Side Guards Increases verall width f chair. Sme interferance may exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard N/A w/ Height Adjustable Arms $140.00 186SG29 K0108 Plastic Lw N/A w/ Ht Adj Arms $140.00 186SG35 K0108 Aluminum N/A w/height Adj. Arms, High Push r Pull Wheel Lcks $235.00 186SG36 186AT37 186SG12 K0108 K0108 Aluminum w/ Fender N/A w/ Height Adj. Arms, High Push r Pull Wheel Lcks Carbn Fiber N/A w/ Height Adj. Arms, High Push r Pull Wheel Lcks $70.00 $140.00 $245.00 $450.00 Spke Guards Nt available with 5 spke MAG wheels. N/A w/ Xtender Pwer Assist 186A23 K0065 Black Spke Guard $115.00 186A302 K0065 Quickie "Q" Clear $115.00 Additinal Pack Accessries 186A1 Backpack - Adult $65.00 186A2 Backpack - Kids $60.00 186A8 Black Seat Puch $50.00 186A203 186A83 E2207 Miscellaneus Crutch Hlder Tl Kit $195.00 $45.00 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Page 5
7. KEY OPTIONS & ACCESSORIES (CONT 186C118 186C140 186C2 186C141 186C10 186C38 186C36 186C14 186C35 186C142 186C143 186C126 186C144 186C147 186C148 186C103 186C114 186C145 186C113 186C8 186C44 Frame Clr Bead Blast Aztec Gld Black (Nt avail as base w/zebra Black Cherry Black Opal Blue Opal Candy Blue Candy Purple Candy Red Electric Blue Evergreen Glw Green Apple Ht Sparkle Pink Mauve Pink Rtbeer Sparkle Silver Sunrise Orange Titanium Clr Paint Yellw Glssy White - Limited Editin 186C112 186C43 186C42 186C108 Custm Frame Clr Desert Camuflage Mssy Oak Camuflage Stars & Stripes Zebra (Chse abve base clr Std with White unless abve base paint is chsen N/A w/ Black Andized Clr Package Frks, Backcane Bracket, Rear Axle Clamp. N/A w/ Frg Legs. Andized parts can be rdered separately 186EB07 Black 186EB08 Blue 186EB09 Green 186EB10 Purple 186EB11 Red 186EB12 Ti Grey Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800 333-4000, Optin #3, Fax: (800 333 9011 Matte Frame Clrs 186C116 Matte Black 186C151 Matte Black Cherry 186C150 Matte Electric Blue 186C149 Matte Evergreen 186C152 Matte Purple Cmmnly Requested Optins Include: Swing Away Knee Adductrs One Arm Drive Unilateral Wheel Lcks Seat Pan Caster Pin Lck Grade Aids Spinergy Clr Spkes Duble D Telescping Push Handles 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 www.sunrisemedical.cm Page 6