list: 27 Spain EUR Dealer Information Contact: Customer Code: Customer Name: Address 1: City: Post code: Phone: Fax: PO: Client Information First Name: Last Name: Diagnosis: Address 1: Address 2: Postal code: City: Country: Phone: e-mail: Client Measurements Weight: Height: 1) Upper leg length: 2) Chest Depth: 3) Seat pan to elbow: 4) Arm pit height: 5) Top of shoulders: 6) Top of head: 7) Elbow to Hand: 8) Chest width: 9) Knee to Foot: 10) Hip width: kg All specifications and prices are subject to change without notice. Please note that displayed prices are only valid if ordered with the wheelchair. Any parts ordered for service or future alterations will carry different prices and warranty. Rabobank Parkstad Limburg Rekening: 1238.24.184 IBAN: NL84RABO0123824184 BIC/SWIFT: RABONL2U europe@permobil.nl Permobil Europe B.V. De Doom 22 NL 6419 CX HEERLEN Phone: +31 (0)45 564 54 90 Fax: +31 (0)45 564 54 91 Page 1 of 8
Chassis Model 103630-99-0 C350 CORPUS VR2 ADVANCED EUR 5,384.00 User manual 103760-99-0 USER MANUAL ES C350 EUR - User manual seat 104727-99-0 USER MANUAL ES CORPUS SEAT EUR - Colour covers 103529-99-0 COVERS C350 BLACK EUR - 103533-99-0 COVERS C350 DARK BLUE METALLIC EUR - 103532-99-0 COVERS C350 RED EUR - 103530-99-0 COVERS C350 SILVER METALLIC EUR - 103531-99-0 COVERS C350 YELLOW EUR - Hub cap 103540-99-0 HUB CAP INCL. REFLECTOR BLACK EUR - 103539-99-0 HUB CAP INCL. REFLECTOR DARK BLUE METALLIC EUR - 103510-99-0 HUB CAP INCL. REFLECTOR RED METALLIC EUR - 103541-99-0 HUB CAP INCL. REFLECTOR SILVER METALLIC EUR - 103542-99-0 HUB CAP INCL. REFLECTOR YELLOW EUR - Front wheels 103557-99-0 WHEELS 2.5-3" SOLID TIRES EUR - Rear wheels 103498-99-0 WHEELS 3.00x8" AIR FILLED TIRES EUR - 103499-99-0 WHEELS 3.00x8" SOLID TIRES EUR 131.00 104871-99-0 WHEEL 3.00-8" MUD/SNOW AIR TIRE (1 pair) EUR 131.00 Drive parameters 103660-99-0 PROGR.SET: C350 VR2/70A ADVANCED 8 KMH EUR - Accessories chassis Batteries 101969-99-0 BATTERIES, 60Ah, SET OF 2 EUR - Charger 104877-99-0 CHARGER PERMOBIL 24V/8A EU EUR - Light kit (+) 103500-99-0 LIGHT KIT C350/VR2 EUR 351.00 _Curb Climber (+) 105443-99-0 CURB CLIMBERS KIT C 350 EUR 385.00 Chassis adaption for Permolock C3 (+) 104626-99-0 ADAPT C300/350 FOR PERMOLOCK C3 EUR 97.00 Reinforcement chassis for Permolock (+) 104637-99-0 REINFORCEMENT C350 CHASSIS FOR PERMOLOCK C3 EUR - Rain cover (+) 101888-99-0 TARPAULIN/RAINCOVER FOR ALL MODLES EUR 108.00 Seat assembly Seat lift system 103888-99-0 POWERED SEAT LIFT 200MM C350 / VR2 EUR 1,050.00 103815-99-0 POWERED SEAT LIFT 200MM C350 (COMB. WITH TILT) EUR 1,050.00 101994-99-0 SEAT TUBE FIXED C300/C350 EUR - 101995-99-0 SEAT TUBE FIXED C/K300 C350 (COMB. WITH TILT) EUR - Seat tilt options 100565-99-0 FIXED SEAT ANGLE 3 CII EUR - 103973-99-0 POWERED ADJ.SEAT TILT 30 VR2 EUR 1,212.00 101988-99-0 POWERED ADJ.SEAT TILT 45 C300/VR2 EUR 1,212.00 Seat Page 2 of 8
Seat 103478-99-0 SEAT 430x410 (FOR BACKR. ADJ. 90-150 ) EUR - 103479-99-0 SEAT 430x460 (FOR BACKR. ADJ. 90-150 ) EUR - 103480-99-0 SEAT 430x510 (FOR BACKR. ADJ. 90-150 ) EUR - 103481-99-0 SEAT 430x560 (FOR BACKR. ADJ. 90-150 ) EUR - 103482-99-0 SEAT 480x460 (FOR BACKR. ADJ. 90-150 ) EUR - 103483-99-0 SEAT 480x510 (FOR BACKR. ADJ. 90-150 ) EUR - 103484-99-0 SEAT 480x560 (FOR BACKR. ADJ. 90-150 ) EUR - Seat cushion 103293-99-0 SEAT CUSHION 420x370 TEXTILE (MESH) EUR - 103294-99-0 SEAT CUSHION 450x420 TEXTILE (MESH) EUR - 103296-99-0 SEAT CUSHION 450x500 TEXTILE (MESH) EUR - 103297-99-0 SEAT CUSHION 450x560 TEXTILE (MESH) EUR - 103299-99-0 SEAT CUSHION 500x500 TEXTILE (MESH) EUR - 103300-99-0 SEAT CUSHION 500x560 TEXTILE (MESH) EUR - 103387-99-0 SEAT CUSHION 420x370 VINYL EUR - 103388-99-0 SEAT CUSHION 450x420 VINYL EUR - 103389-99-0 SEAT CUSHION 450x500 VINYL EUR - 103390-99-0 SEAT CUSHION 450x560 VINYL EUR - 103391-99-0 SEAT CUSHION 500x500 VINYL EUR - 103392-99-0 SEAT CUSHION 500x560 VINYL EUR - 103292-99-0 WITHOUT SEAT CUSHION EUR -131.00 Backrest 101010-99-0 BACKR. 340x535 EUR - 100737-99-0 BACKR. 340x605 EUR - 101011-99-0 BACKR. 390x535 EUR - 100738-99-0 BACKR. 390x605 EUR - 101012-99-0 BACKR. 440x535 EUR - 100739-99-0 BACKR. 440x605 EUR - 100740-99-0 BACKR. 340 WIDE WITHOUT PLATE EUR -166.00 100741-99-0 BACKR. 390 WIDE WITHOUT PLATE EUR -166.00 100742-99-0 BACKR. 440 WIDE WITHOUT PLATE EUR -166.00 101962-99-0 BACK BIO-MECH. 390x605 EUR 296.00 101963-99-0 BACK BIO-MECH. 440x605 EUR 296.00 Backrest cushion 103310-99-0 BACKREST CUSHION 340x535 TEXTILE (MESH) EUR - 103311-99-0 BACKREST CUSHION 340x605 TEXTILE (MESH) EUR - 103312-99-0 BACKREST CUSHION 390x535 TEXTILE (MESH) EUR - 103313-99-0 BACKREST CUSHION 390x605 TEXTILE (MESH) EUR - 103314-99-0 BACKREST CUSHION 440x535 TEXTILE (MESH) EUR - 103315-99-0 BACKREST CUSHION 440x605 TEXTILE (MESH) EUR - 103322-99-0 BACKREST CUSHION 340x535 VINYL EUR - 103323-99-0 BACKREST CUSHION 340x605 VINYL EUR - 103324-99-0 BACKREST CUSHION 390x535 VINYL EUR - 103325-99-0 BACKREST CUSHION 390x605 VINYL EUR - 103326-99-0 BACKREST CUSHION 440x535 VINYL EUR - 103327-99-0 BACKREST CUSHION 440x605 VINYL EUR - 103309-99-0 WITHOUT BACKREST CUSHION EUR -164.00 Cover backrest (+) 104826-99-0 COVERS / WITHOUT BACKREST EUR - Adjustment backrest 103698-99-0 POWERED ADJ. BACKREST CORPUS C300-C350 EUR 947.00 103527-99-0 MANUAL ADJUST. BACKREST CORPUS/C300-C350 EUR - Legrest 104086-99-0 LEGREST 1-P FOOTPLATE EUR - 101966-99-0 LEGREST 2-P FOOTPLATES 20CM EUR - 104085-99-0 LEGREST 2-P FOOTPLATES 16CM AND COVER EUR - 104640-99-0 WITHOUT LEGREST CII EUR -432.00 Adjustment legrest 102206-99-0 MANUAL ADJUSTMENT LEGREST C300/C EUR - 102207-99-0 POWERED ADJ. LEGREST C300/C EUR 1,050.00 Page 3 of 8
Adjustment legrest 103997-99-0 WITHOUT LEGREST ADJUSTMENT EUR - Armrest Right 103331-99-0 ARMREST 250MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103339-99-0 ARMREST 250MM,RIGHT VINYL (PU FOAM) EUR - 103333-99-0 ARMREST 300MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103341-99-0 ARMREST 300MM,RIGHT VINYL (PU FOAM) EUR - 103335-99-0 ARMREST 350MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103343-99-0 ARMREST 350MM,RIGHT VINYL (PU FOAM) EUR - 103337-99-0 ARMREST 400MM,RIGHT TEXTILE (BLACK TRIVERA) EUR - 103345-99-0 ARMREST 400MM,RIGHT VINYL (PU FOAM) EUR - 101351-99-0 WITHOUT ARMREST, RIGHT (BODY AND UPHOLSTERY) EUR -52.00 Armrest Left 103330-99-0 ARMREST 250MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103338-99-0 ARMREST 250MM,LEFT VINYL (PU FOAM) EUR - 103332-99-0 ARMREST 300MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103340-99-0 ARMREST 300MM,LEFT VINYL (PU FOAM) EUR - 103334-99-0 ARMREST 350MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103342-99-0 ARMREST 350MM,LEFT VINYL (PU FOAM) EUR - 103336-99-0 ARMREST 400MM,LEFT TEXTILE (BLACK TRIVERA) EUR - 103344-99-0 ARMREST 400MM,LEFT VINYL (PU FOAM) EUR - 101353-99-0 WITHOUT ARMREST, LEFT (BODY AND UPHOLSTERY) EUR -52.00 Armrest height adjustment 100523-99-0 ARMRESTS OVER 100MM HEIGHT ADJUSTMENT EUR 62.00 101744-99-0 ARMRESTS OVER 50MM HEIGHT ADJUSTMENT (STD) EUR - Armrests reinforcement (+) 101510-99-0 ARMREST REINFORCEMENT KIT HIGH EUR 115.00 Armrest configuration 101003-99-0 ARMRESTS HIGH MOUNTED EUR - 101002-99-0 ARMRESTS LOW MOUNTED EUR - Accessories seat Headrest (+) 103460-99-0 HEAD SUPPORT "ERGO" TEXTILE (BLACK TRIVERA) EUR 358.00 104130-99-0 HEAD SUPPORT, ADJUSTABLE TEXTILE (BLACK TRIVERA) EUR 215.00 104131-99-0 HEAD SUPPORT, ADJUSTABLE VINYL EUR 215.00 100712-99-0 WITHOUT HEADREST * EUR - Accessories rail headrest (+) 103697-99-0 ACCESSORIES RAIL HEAD SUPPORT EUR 43.00 Lateral support (+) 103050-99-0 LATERAL SUPPORTS SMALL(A) 150x140 TEXTILE (MESH) EUR 261.00 103056-99-0 LATERAL SUPPORTS MED(F) 220x90 TEXTILE (MESH) EUR 267.00 103062-99-0 LATERAL SUPPORTS LARGE(E) 220x150 TEXTILE (MESH) EUR 272.00 Mounting set lateral support (+) 103425-99-0 MOUNTING KIT LATERAL SUPPORTS (BACKREST 340MM) EUR - Thigh support (+) 103092-99-0 THIGH SUPPORTS TEXTILE (MESH) 110x90 SMALL (B) EUR 329.00 103094-99-0 THIGH SUPPORTS TEXTILE (MESH) 165x120 MEDIUM (J) EUR 335.00 103095-99-0 THIGH SUPPORTS TEXTILE (MESH) 200x90 LARGE (C) EUR 341.00 102977-99-0 THIGH SUPPORTS TEXTILE (MESH) 300x90 XLARGE (G) EUR 346.00 Hip support (+) 103077-99-0 HIP SUPPORTS SMALL (B) 110x90 TEXTILE (MESH) EUR 329.00 103079-99-0 HIP SUPPORTS MEDIUM (A) 150x140 TEXTILE (MESH) EUR 335.00 103081-99-0 HIP SUPPORTS LARGE (C) 200x90 TEXTILE (MESH) EUR 341.00 103083-99-0 HIP SUPPORTS X LARGE (D) 200x200 TEXTILE (MESH) EUR 346.00 Calf support (+) 103053-99-0 CALF SUPPORTS LARGE (A)150x140 PU FOAM EUR 266.00 103055-99-0 CALF SUPPORTS SMALL (B)110x90 TEXTILE (MESH) EUR 203.00 102982-99-0 CALF SUPPORTS MEDIUM/FLAT (J)165x120 TEXTILE (MESH) EUR 227.00 Page 4 of 8
Calf support (+) 103058-99-0 CALF SUPPORTS LARGE (A)150x140 TEXTILE (MESH) EUR 266.00 102978-99-0 CALF SUPPORTS XLARGE (H)170x175 TEXTILE (MESH) EUR 253.00 103060-99-0 CALF SUPPORTS XXLARGE (D)200x200 TEXTILE (MESH) EUR 316.00 Seatbelt (+) 104514-99-0 BELT 2-POINT LARGE NONPAD BODYPOINT INCL BRACK UT EUR 99.00 104516-99-0 BELT 2-POINT LARGE PADDED BODYPOINT INCL BRACK UT EUR 142.00 104518-99-0 BELT 2-POINT MEDIUM NONPA D BODYPOINT INCL BRACK UT EUR 92.00 104520-99-0 BELT 2-POINT MEDIUM PADDE D BODYPOINT INCL BRACK UT EUR 134.00 100600-99-0 SAFETY BELT,AUTOTENSION LONG VERSION EUR 118.00 100518-99-0 SAFETY BELT,BUCKLE EUR 49.00 100529-99-0 SAFETY BELT,4-POINT EUR 202.00 100519-99-0 SAFETY BELT,AUTOTENSION EUR 118.00 Mounting position seatbelt (+) 105010-99-0 MOUNT POS SEATBELT ROLL RIGHT EUR - 105011-99-0 MOUNT POS SEATBELT ROLL LEFT EUR - Support handles set (+) 103651-99-0 TRANSFER HANDLES, SET (pair) UNI-TRACK EUR 141.00 Stump support (+) 103067-99-0 STUMP SUPPORT SMALL (A) 150x140 TEXTILE (MESH) EUR 131.00 103068-99-0 STUMP SUPPORT MEDIUM (J) 165x120 TEXTILE (MESH) EUR 136.00 103070-99-0 STUMP SUPPORT LARGE (H) 170x175 TEXTILE (MESH) EUR 141.00 103071-99-0 STUMP SUPPORT XLARGE (D) 200x200 TEXTILE (MESH) EUR 147.00 Mounting position stump support (+) 105009-99-0 MOUNT POS AMPUTATION SUPP -ORT LEFT EUR - 105008-99-0 MOUNT POS AMPUTATION SUPP -ORT RIGHT EUR - Accessories rail (+) 103176-99-0 ACCESSORIES RAIL EUR - 103177-99-0 ACCESSORIES RAIL +50 EUR - 103178-99-0 ACCESSORIES RAIL +100 EUR - 105675-99-0 UNITRACK BAR ACCESSORIE -100 EUR - 105676-99-0 UNITRACK BAR ACCESSORIE -50 EUR - 103468-99-0 WHITOUT ACCESSORIES RAIL EUR - Abduction wedge (+) 100978-99-0 ABDUCTION WEDGE, VINYL EUR 370.00 Support armrest inside Right (+) 101263-99-0 ARMREST SUPPORT,VINYL RIGHT INSIDE EUR 74.00 Support armrest inside Left (+) 101264-99-0 ARMREST SUPPORT,VINYL LEFT INSIDE EUR 74.00 Support armrest outside Right (+) 101261-99-0 ARMREST SUPPORT,VINYL RIGHT OUTSIDE EUR 74.00 Support armrest outside Left (+) 101262-99-0 ARMREST SUPPORT,VINYL LEFT OUTSIDE EUR 74.00 Push handles back (+) 100975-99-0 PUSH HANDLES,MOUNTED ON THE BACKREST EUR 182.00 Support handle armrest (+) 103194-99-0 SUPPORT HANDLE ARMREST CORPUS EUR 114.00 Table Swing able (+) 103982-99-0 TABLE,SWING AWAY 600MM FOR JOYSTICK L/R EUR 452.00 103983-99-0 TABLE,SWING AWAY 650MM FOR JOYSTICK L/R EUR 452.00 Mounting position table (+) 105021-99-0 MOUNT POS TABLE SWINGABLE LEFT EUR - 105020-99-0 MOUNT POS TABLE SWINGABLE RIGHT EUR - Table adjust angel (+) 100576-99-0 TABLE,ANGLE ADJUST.390MM BACK WIDTH, REMOVABLE EUR 384.00 100577-99-0 TABLE,ANGLE ADJUST.440MM BACK WIDTH, REMOVABLE EUR 384.00 103426-99-0 TABLE,ANGLE ADJUST. 1-SIDE FIXATION EUR 426.00 Table small for armrest mount (+) 101691-99-0 COLLEGE TABLE,LEFT EUR 229.00 Page 5 of 8
Table small for armrest mount (+) 100578-99-0 COLLEGE TABLE RIGHT EUR 229.00 Incontinence protection (+) 102808-99-0 INCONTINENCE PROTECTION 430x360/430x410 EUR 46.00 102807-99-0 INCONTINENCE PROTECTION 430x460/430x510/430x560 EUR 49.00 102809-99-0 INCONTINENCE PROTECTION 480x410 EUR 49.00 102806-99-0 INCONTINENCE PROTECTION 480x460/480x510/480x560 EUR 55.00 Comfort seat cushion (+) 104739-99-0 SEAT CUSHION COMFORT 450x420,TEXTILE (MESH) EUR 285.00 104740-99-0 SEAT CUSHION COMFORT 450x450,TEXTILE (MESH) EUR 285.00 104741-99-0 SEAT CUSHION COMFORT 450x530,TEXTILE (MESH) EUR 285.00 104742-99-0 SEAT CUSHION COMFORT 450x560,TEXTILE (MESH) EUR 285.00 104744-99-0 SEAT CUSHION COMFORT 500x530,TEXTILE (MESH) EUR 285.00 104743-99-0 SEAT CUSHION COMFORT 500x500,TEXTILE (MESH) EUR 285.00 104745-99-0 SEAT CUSHION COMFORT 500x560,TEXTILE (MESH) EUR 285.00 104725-99-0 SEAT CUSHION COMFORT 450x500,TEXTILE (MESH) EUR 285.00 Comfort seat plate (+) 101227-99-0 SEAT PLATE COMFORT 430x460/510 EUR 147.00 Armrests sidewarts flip-up (+) 102322-99-0 ARMREST SIDEWARTS FLIP-UP EUR 355.00 Armrest pouch Right (+) 100671-99-0 ARMREST POUCH,RIGHT EUR - Armrest pouch Left (+) 100672-99-0 ARMREST POUCH,LEFT EUR - Seat frame pouch (+) 102588-99-0 SEATFRAME POUCH EUR 30.00 Bag hooks (+) 105805-99-0 BAG HOOKS OPEN EUR 32.00 Back pack (+) 102059-99-0 BACK PACK INCL. HOOKS EUR 294.00 _Rear View Mirror Left (+) 105818-99-0 REAR VIEW MIRROR UNITRACK SEAT FRAME LEFT EUR 134.00 _Rear View Mirror Right (+) 105819-99-0 REAR VIEW MIRROR UNITRACK SEAT FRAME RIGHT EUR 134.00 Cup/Cellphone holder (+) 103044-99-0 CUP/PHONE HOLDER EUR 20.00 Foot straps (+) 103427-99-0 FOOTSTRAPS WITHOUT PADS EUR 29.00 103104-99-0 FOOTSTRAPS WITH PADS EUR 65.00 Lumbar support (+) 101972-99-0 LUMBAR SUPPORT,AIR EUR 148.00 Crutch holder (+) 101956-99-0 CRUTCH HOLDER EUR 116.00 Holder oxygen bottle (+) 101964-99-0 HOLDER OXYGEN BOTTLE CORPUS EUR 212.00 User control User control 103613-99-0 JOYSTICK VR2 ADVANCED WITH SEAT/LIGHT BUTTONS EUR - Joystick holder (+) 104302-99-0 PANELHOLDER PAR. SW. AWAY VR2/R-NET L/R EUR - Mounting position joystick (+) 105032-99-0 MOUNT POS CONTROLBOX LEFT EUR - 105031-99-0 MOUNT POS CONTROLBOX RIGHT EUR - Joystick knobs (+) 101165-99-0 JOYSTICK KNOB BALL SMALL EUR 12.00 100962-99-0 JOYSTICK KNOB BALL BIG EUR 15.00 Page 6 of 8
Joystick knobs (+) 100960-99-0 JOYSTICK KNOB CHIN CUP EUR 15.00 100964-99-0 JOYSTICK KNOB MUSHROOM EUR 26.00 100963-99-0 JOYSTICK KNOB SOFT BALL EUR 26.00 100965-99-0 JOYSTICK KNOB STICK EUR 26.00 100961-99-0 JOYSTICK KNOB T-GRIP EUR 40.00 105442-99-0 JOYSTICK SOFTBALL BLACK WITH CONE EUR 23.00 Attendant control Attendant control (+) 104223-99-0 JOYSTICK ATTENDANT VR2 EUR 887.00 Supplementary accessories Split backrest (+) 100972-99-0 SPLIT BACKREST EUR 113.00 Chest support table (+) 101303-99-0 CHEST SUPPORT FOR TABLE CII/VII VINYL EUR 180.00 Permolock Permolock C3 (+) 104022-99-0 PERMOLOCK C3 WITH STANDARD SWITCH EUR 861.00 Manual Permolock (+) 104722-99-0 USER MANUAL ES PERMOLOCK C3 EUR - Release lever (+) 102841-99-0 MANUAL RELEASE FOR PERMOLOCK C EUR 170.00 Quicklock holder release lever (+) 102859-99-0 QUICKLOCK HOLDER RELEASE LEVER EUR 54.00 Spacer kit (+) 102864-99-0 SPACER KIT PERMOLOCK C EUR 7.00 Install kit fixed (+) 101411-99-0 PERMOLOCK SNAP IN KIT EUR 145.00 Seat adapter (+) 104708-99-0 CAR SEAT ADAPTER PERMOLOCK C3 EUR 323.00 Wheel bump (+) 104707-99-0 WHEEL BUMP FOR PERMOLOCK C3 EUR 28.00 Extension cable Permolock (+) 104232-99-0 EXTENSION CABLE FOR PERMOLOCK C,C3 EUR 54.00 Chair Order Policy: For other options and special adaptations, please call Permobil for further details. Please also refer to Permobil s Delivery Policy for further information. Your order cannot be processed without the following: - The client s name - The client s measurements - The client s weight Page 7 of 8
For your ordering, please sign below with date and company stamp. Signature: Date: Company Stamp: An order confirmations will be provided by Permobil summarizing the items selected. Please review this carefully. Page 8 of 8