Im Hofstätt 11 D- 72359 Dotternhausen Tel +49 (0)7427 9480-0 Fax +49 (0)7427 9480-7025 e-mail info@proactiv-gmbh.de www.proactiv-gmbh.de Quotation date: Order date: according to GTC PRO ACTIV GmbH Speedy F1 oversized rigid frame sports wheelchair Individual customised frame geometry,welded chassis Approved up to 120 kg user load capacity 9011100000 4,120.00 Medical suppliers / Company address: Cust. no.: Phone: Fax: E-mail: Contact: Invoice address: same as company address Invoice address: other (see below) Cust. no.: Phone: Fax: E-mail: Contact: Shipping address:same as company address other (see below) Speedy F1 basket Speedy F1 dance Customer name / commission: Phone: Fax: E-mail: Date of birth: Paying organisation: Indication: Speedy F1 tennis Speedy F1 badminton - 1-2017-09-19 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required
Basic size Body size: Body Körpergröße: size: Weight: Gewicht: cm cm kg kg Lower Unterschenkellänge: leg length: cm cm (anatomic (anatomisches dimension: Maß: Kniekehle hollow of the bis Fußsohle) knee to the foot sole) Individual frame geometry oversized: 9011100001 Wheel chair dimensions: A: SB seat width I: Frame length to the front frame bend B: ST seat depth J: KW knee angle or J1: Angle of the front C: RH back height Frame tube to the vertical position D: USL lower leg length M: Lower leg width top E: SHh seat height back N: Lower leg width bottom F: SHv seat height front O: Position of the tip support bearing block (according to the rules in basketball, the rear wheel forms the back-most point) G: KP tipping point (inner edge rear tube to axis middle drive wheel) P: Position of the steering wheel bearing block (distance from the inner edge backrest to middle bearing block) H: Start frame retraction Q: Distance between steering wheel bearing blocks Dimensional tolerances according to DIN EN ISO 13920 apply for the design (mm) Degree of accuracy Up to 30 More then 30 to 120 More then 120 to 400 More then 400 to 1000 C +/- 1 +/- 3 +/- 4 +/- 6-2 - 2017-09-19 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required
Frame colour - One-colour design Information on current colour designs and example images under: www.proactiv-gmbh.de/farben.php White RAL 9016 gloss 9000100170-023 matt 9000100170-123 Brilliant Silver gloss 9000100170-011 Anthrazit RAL 7016 gloss 9000100170-001 matt 9000100170-101 Black RAL 9005 gloss 9000100170-003 matt 9000100170-019 Deep black, silver effect gloss 9000100170-007 Pure orange RAL 2004 gloss 9000100170-022 Fire Red gloss 9000100170-018 matt 9000100170-118 Pink magenta RAL 4010 gloss 9000100170-037 matt 9000100170-137 Sky blue gloss 9000100170-017 Pastel blue RAL 5024 gloss 9000100170-036 matt 9000100170-136 Navy blue gloss 9000100170-045 matt 9000100170-145 Apple green gloss 9000100170-014 matt 9000100170-114 Lemon green gloss 9000100170-005 matt 9000100170-105 Purple gloss 9000100170-044 Yellow RAL 1023 gloss 9000100170-046 matt 9000100170-146 Red RAL 3001 gloss 9000100170-047 matt 9000100170-147 Colour - Attachment parts Drive wheel Aluminium rim and hub Caster fork and bearing block silver 9000100171-011 9000100173-011 Rahmenfarbe Frame colour - - Einfarbdesign Two-colour design Information on current colour designs and example images under: www.proactiv-gmbh.de/farben.php Note: With two-colour design, according to both colours of the gloss level of the design colour. Two-colour design 205.90 comprising one basic colour (on the back of the frame) and one design colour (on the front of the frame) Please select from the following colours: Base colours (on the back frame): White 9000100170-200 Silver 9000100170-201 Anthracite 9000100170-202 Black 9000100170-203 Pastel blue 9000100170-206 Lemon green 9000100170-207 Yellow 9000100170-208 Design colours (on the front frame) Yellow gloss 9000100170-261 matt 9000100170-262 Lemon green gloss 9000100170-250 matt 9000100170-251 Blue gloss 9000100170-252 matt 9000100170-263 Chili gloss 9000100170-253 matt 9000100170-254 Pure orange gloss 9000100170-255 matt 9000100170-256 Cappuccino gloss 9000100170-257 matt 9000100170-258 Black black 9000100171-003 9000100173-003 If no details have been made, the attachment parts are mounted in black. Attachment parts colour design according to customer desires: Drive wheel 1 Aluminium rim and hub Orange 144.390 1 RAL 2004 9000100171-022 white RAL 9016 144.90 1 9000100171-023 in frame colour Selection from single colour design deviating from the frame colour 176.10 1 9000100171-999 206.20 1 9000100171-998 5" Aluminium rim 2 3 spoke design 30.70 2 9000100174-022 30.70 2 9000100174-023 51.50 2 9000100174-999 60.80 2 9000100174-998 Please enter the last 3 digits of the desired colour (single colour design): 9000100170-9000100170- gloss 9000100170-259 matt 9000100170-260 Special colour requests (frame or attachment parts) Frame colour single procurement Frame from RAL range of colours Surface coating: gloss matt - 3-2017-09-25 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position selected Colours Rev. 02 9000100170-100 317.20 Colour details with RAL number Note: Attachment parts not possible in design colours 1 Only in combination with aluminium rim drive wheel 9000203000-9000203300 2 Only in combination with caster wheel 5" Aluminium rim 3-spoke design smooth running 9000501200 or 5" Aluminium rim 3-spoke design good shock absorption 9000501210
Backrest Aluminium side guard, contour following the wheel 9011400020-002 Bolted backrest, cannot be folded Adapted to the upper edge of the tyre, in frame colour Aluminium side guard, contour by indicated dimension 9011400020-001 70.70 Bolted backrest, cannot be folded Indicated dimension: A= cm / B= cm Welded side guard with alu plate, contour following the wheel 9011400400-002 297.90 Bolted backrest, cannot be folded, Adapted to the upper edge of the tyre, in frame colour (3 cm above the tyre) Welded side guard with alu plate, contour by indicated dimension 9011400400-001 338.00 Bolted backrest, cannot be folded, Adapted to the upper edge of the tyre, in frame colour Indicated dimension: A= cm / B= cm Folding backrest 9011400010 247.50 and 7-way angle adjustment, with integrated aluminium side parts Back equipment Adaptable back with back padding 9011802010 Colour: black (Equipment with back bar extended by 120 mm) Open belt system 9011801010 58.80 Seat cushion "Standard" seat cushion F1 Höhe: 3cm 9000805190-003 103.50 Höhe: 4cm 9000805190-004 103.50 Höhe: 6cm 9000805190-006 103.50 Cover: black breathable Further seat cushions e.g. "Anti- Decubitus" see separate dimension sheet:"pro ACTIV Seat and back systems" Wheel camber * Total width with tight-mounted hand rim 12 drive wheel camber 9011202090 15 drive wheel camber 9011202150 18 drive wheel camber 9011202160 20 drive wheel camber 9011202170 Footrest Continuous footrest with tubular resting bracket 9011601010 height adjustable +/- 3 cm Continuous footrest with rubber coated footplate Further back systems e.g. ergonomic back shell see separate dimension sheet: "PRO ACTIV seat and back systems" Seat upholstery Body Contour 9011801025 9011610000 92.60 height adjustable +/- 3 cm edge-folded at front, bolted Depth: 27cm Continuous footrest with footplate "Box-Form" 9011610020 164.30 height adjustable +/- 3 cm rubber coated Width: 20cm, Length: 31.5cm + 1.5cm adjustable - 4-2017-09-19 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required
Ram bar Offence bar 9011100500 203.80 with radius tube Offence bar with trapezium tube 9011100501 203.80 Defence bar, removable 9011100502 203.80 Rear protection bar 9011100600 182.00 with bent tube Adaptations Central anti-tipping support oversized, welded (basket ball) with screwed axle 9011300378 with quickrelease axle 9011300374 2 anti-tipping supports with oversized tube with screwed axle 9011300170 with quickrelease axle 9011300270 274.60 307.60 355.70 449.30 Central anti-tipping support with oversized tube, length adjustable (Tennis) 9011300370 338.00 fixed tipping wheel rotary fork Mittelkippstütze abnehmbar 4 Dance 9000300010 411.80 über Schnellspannklammer, mit drehbarer Lenkradgabel und Skaterolle Ø80mm in Bodenfreiheit und Winkel einstellbar Farbe: schwarz Caster wheels All caster wheels (except pneumatic tyres) are puncture-proof! 3" Skate wheel (80 mm) 9000501110 54.20 puncture-proof Drive wheels 24" drive wheel, 36 spoke aluminium rim 9000203000 with aluminium front hub, radially spoked (ETRTO 540) Drive wheel double rim 36 spokes 24" (ETRTO 540) 9000203100 25" (ETRTO 559) 9000203200 126.90 126.90 26" (ETRTO 590) 9000203300 126.90 28" (ETRTO 622) 126.90 9000203310 with aluminium front hub, spoked radially Use with higher loads and body weight > 120 kg! Spinergy running wheel "Spox Sport" with 24 PBO spokes; rim, hub and spokes in black 24 (ETRTO 540) 9000203550 561.40 25 (ETRTO 559) 9000201559 561.40 26 (ETRTO 590) 9000203555 Handrims x = dimension handrim attachment! Handrim attachment: x = 11mm x = 19mm 561.40 If no specification is given, the handrims will be mounted wide (19mm/18mm). Ø 19 mm stainless steel handrims 9000205010-004 9000205010-006 for 28" wheel 9000205010-008 Ø 19 mm aluminium handrims silver anodised 9000205019-004 Ø 19 mm aluminium handrims polished and hard-anodised 9000205030-004 124.80 9000205030-006 124.80-5 - 2017-09-19 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required
Ø 19 mm titanium handrims 9000205040-004 257.90 9000205040-006 Silicone handrim cover for 24" hand rim 9000205100-004 for 26" hand rim 9000205100-006 Surface without structure compatible with handrim Ø 19mm or Ø 20mm. Spoke guard Finger- and spoke guard "transparent" for 24" wheel 9000206300-004 257.90 187.10 187.10 158.60 9000206300-006 158.60 basket 9000206310-001 110.80 silly-bubble 28x1" high pressure smooth running 7.5 bar 9000204000-008 (ETRTO 622) Schwalbe "SpeedAir" Indoor sports tyre 10 bar 24x3/4 (540-20) 9000204121-004 35.50 25x3/4 (559-20) 9000204121-005 35.50 26x3/4 (590-20) 9000204121-006 Colour: white, black wall Accessories 35.50 Hand air compressor with pressure gauge up to 14 bar 9000901100 85.50 Transport bag for drive wheels for 24" wheel 9000903530-004 Ø76cmx2cm 9000903530-006 Ø83cmx2cm Your additional notes: 59.50 59.50 9000206310-002 110.80 blue-sky 9000206310-003 110.80 colour-stones 9000206310-004 110.80 Tyres Schwalbe "RightRun" High-pressure tyre 7.5 bar 24x1 (540-25) 9000204000-004 25x1 (559-25) 9000204000-005 26x1 (590-25) 9000204000-006 I herewith confirm the details listed above Location, Date Signature (End customer) Location, Date Signature (Dealer) - 6-2017-09-19 / The prices are plus statutory value-added tax and shipping costs = Included in the basic price = Position required