Quickie QX July 2017

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Quickie QX July 2017 EIF6 Mark For: Submitting for: Date: PO#: Quote Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Contact: Ship To: Dealer Address: Attention: Dealer City: Dealer Phone: ( PV: PC: Fax: ( Address: Address: Confirmation Email: Confirm Via: PV: Ship To City: Option # Fax Ship To Phone: ( Email Definition Price Option # PC: Fax: ( Definition Price 1. FRAME Base Model Quickie QX (Fixed Axle 265 lbs 196WM94 196TO38 Transit Transit System WC19 196W5 196W6 196W7 196W8 196W9 196W10 196W11 20" Frame Depths equals Seat Depths. 196SD7 196SD8 196SD9 196SD10 196SD11 196SD71 196SD13 20" 196SL1 196SL6 Seat Sling Standard Seat Sling Omit Seat Sling -$20.00 196QC01 196QC02 196QC03 JAY Cushions (Optional To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part number must be filled out with desired width and depth JAY Bundled Cushion 196JC20 Cushion Name or Part # For sizes use E1236 $1,803.00 Frame Style See Seat Height Matrix on page 2 196FS9 Standard Frame 196FS30 Hemi Frame $363.00 2. SIZE / SEATING Frame Width Custom Seating Surefit Configurfit JayFit Quickie QX, Ultra Lightweight Folding Wheelchair Seat Depth Width: Depth: Quickie QX featuring the Jay X2 cushion Page 1 Price List

3. CASTERS / SEAT HEIGHT Front Seat Height See Front Seat Height Matrix. 12.5 & 13.0 only available w/ 60 hanger 12.5" & 13" only available w/ Alum Angle Adj Footplate 196SH34 12.5" 196SH14 196SH35 13.0" 196SH15 196SH40 13.5" 196SH16 196SH41 14.0" 196SH17 196SH42 14.5" 196SH18 196SH12 15.0" 196SH20 196SH13 15.5" 196SH21 196SH23 196CW3 196CW44 196CW5 196CW7 196CW34 196CW35 196CW32 196CW39 Caster Wheels 4" Low Profile Polyurethane 4" x 1.25" Semi Pneumatic 5" Low Profile Polyurethane 5" x 1.5" Semi Pneumatic 6" Polyurethane 6" x 1.5" Semi Pneumatic 8" Polyurethane 8" x 1.5" Semi Pneumatic 196CF71 196CF12 196CF17 196CF23 Caster Fork 3.5" (standard stem bolt only 5.25" 6" 7" 16.0" 16.5" 17.0" 17.5" 18.0" 18.5" 19.0" 19.5" 196CS1 196CS5 196CS9 Caster Stem Bolt Standard 3/4" 1 1/2" Front Seat Height Matrix $98.00 $98.00 $130.00 4. REAR WHEELS / REAR SEAT HEIGHTS Rear Seat Height See Rear Seat Height Matrix. 12.5" & 18.5" RSH not available with fixed axle. 12" 196RH9 13" 196RH11 13.5" 196RH12 196RH13 14.5" 196RH14 196RH15 15.5" 196RH16 196RH17 16.5" 196RH18 196RH19 17.5" 196RH26 196RH20 196RH21 Rear Wheel Tire See Rear Tire & Wheel Matrix for availability 196RT1 Pneumatic 196RT2 Pneumatic w/ Airless Insert 196RT3 Full Poly 196RT39 High-Pressure Clincher Black Handrim Natural Fit only available w/ 22, 24, 25 Lite Spoke. Plastic NA w/ 25, 26" Aluminum Anodized 196HR1 Plastic 196HR4 Natural Fit - Standard Grip 196HR22 Natural Fit - Super Grip 196HR23 Seat Squeeze Matrix Rear Wheel Size See Rear Tire & Wheel Matrix for availability 196RW3 20" Mag Wheel 196RW8 22" Mag Wheel 196RW1 24" Mag Wheel 196RW103 20" Mag Wheel 5 Spoke 196RW104 22" Mag Wheel 5 Spoke 196RW102 24" Mag Wheel 5 Spoke 196RW90 20" Lite Spoke Wheel 196RW91 22" Lite Spoke Wheel 196RW92 24" Lite Spoke Wheel 196RW94 26" Lite Spoke Wheel 196RW25 Omit $113.00 -$43.00 Rear Seat Height Matrix Page 2 $221.00 $93.00 $130.00 $335.00 $389.00

4. REAR WHEELS / REAR SEAT HEIGHTS (CONT Rear Tire & Wheel Matrix One Arm Drive Available only with 24" MBL Lite spoke wheels. Std Aluminum black handrim 196AL16 One Arm Drive Adj. Axle Plate Right Hand Mount 196HM1 Left Hand Mount 196HM2 196AX1 196AX11 196AX45 Axle Quick Release Steel Quad Quick Release Steel NA on Spoke Threaded Axle $1,239.00 $163.00 $134.00 5. WHEEL LOCKS 196WL1 196WL2 196WL30 196WL24 196WL23 196WL10 196WL12 Wheel Lock High Mount Push High Mount Pull Compact Unilateral Wheel Lock Right Unilateral Wheel Lock Left Omit Wheel Lock Do Not Mount Extension Handle Ext. handles only available with high mount push or pull wheel locks 196EH7 Extension Handle (Pair $65.00 6. HANGERS AND FOOTRESTS Front Hangers Footplate mounts with Extension Tube using clamping hardware 196H145 60 Swing In/Out Hanger 196H139 70 Swing In/Out Hanger 196H141 80 Swing In/Out Hanger Articulating Hanger 196H159 196H160 196H161 Only available w/ front mount alum angle adj footplates and -22" width 196H144 Omit Hanger & Footplate -$16.00 NA w/ Alum Angle Adj Front Mount footplates. Elevating Hanger - Ext Mount NA w/ Alum Angle Adj Front Mount footplates. $471.00 Elevating Hanger - Front Mount Extension Tubes See Lower Leg Length Matrix for range 196E1 Short 196E2 Medium 196E5 Long Footplate Heel loop not included, see Footplate Option section below 196F1 Composite Footplate 196F271 196F3 196F5 196HL12 1968A02 Composite Angle Adj (-22"w $157.00 Aluminum Angle Adj. Footplate Aluminum Only available w/elevating Legrest $157.00 Hanger & Footplate Options Adjustable Heel Loop Gel Cover For Hangers (Pair 206 $35.00 7. BACKREST / SEATING 196BT10 196BT100 Back Type Standard Angle Adjustable Back 196B5 196B9 Backrest Height Med (13"- Tall (-20" $319.00 Push Handles Integral Push Handles, Folding Height Adjustable & Omit 8 for Std Backrest, Straight for Angle Adj. Backrest 196PH6 Integral Push Handles Fold-Down Push Handles Only available with Adjustable Upholstery. Used in combination w/angle Adjust only avail in 20" back height $151.00 196PH17 Folding Push Handle with Ht. Adj. Back $278.00 196PH2 Omit Push Handles 196PH5 Page 3

7. BACKREST / SEATING (CONT Back Upholstery Standard Upholstery Standard Upholstery EXO Backrest Tension Adj Ballistic Nylon *Reference 186BU70 for billing 196BU1 196BU88 196BU70 196BU71 196BU89 196BU14 Backrest Tension Adj 3DX Vented *Reference 186BU71 for billing Backrest Tension Adj EXO *Reference XXXBU89 for billing Omit Back Upholstery 196JB01 JAY Backs JAY Back (see Order forms $67.00 $379.00 $422.00 $402.00 -$20.00 196VU1 196VU2 196VU3 196VU4 196VU12 196VU5 196VU8 196VU9 196VU10 196VU11 196VU13 Military Service Patches US Marines Patch US Army Patch US Navy Patch US Air Force Patch US Coast Guard Purple Heart Purple Heart with Marines Patch Purple Heart with Army Patch Purple Heart with Navy Patch Purple Heart with Air Force Patch Purple Heart with Coast Guard Price List 8. ARMREST / SIDEGUARDS Armrest - Padded Swing Away Some limitations when used with the Angle Adjustable Back in the rear most setting Please circle a setting, will default to 11" if no selection is made 196AA18 Setting Padded Swing-Away STD (9" to 13" 9" 10" 11" 12" Armpad - For Height Adjustable Desk Length (10" Full Length - Full ( 196AM23 196AM24 1968A01 Armrest Options Gel Cover For Swing Away Arms (pair 196SG33 196SG29 Side Guards Plastic - Standard (8.5" High Plastic - Low (6.5" High $168.00 $168.00 1964A01 1964A02 Spoke Guards Quickie Black Spoke Guard Quickie Clear Spoke Guard $141.00 $141.00 1968A03 196A2100 Miscellaneous Caddy Crutch Holder $81.00 $103.00 196C116 196C151 196C150 196C149 196C152 Matte Frame Colors Matte Black Matte Black Cherry Matte Electric Blue Matte Evergreen Matte Purple 196C112 196C43 196C42 Custom Frame Color Desert Camouflage Mossy Oak Camouflage Stars & Stripes Zebra (Choose above base color Std with 196C108 White unless above base paint is chosen NA w/ Blk, Matte Black, Blk Opal, Titanium $249.00 13" Armrest - Height Adjustable Flip Back HA Classic NA w / - depth 196AA104 196AA105 196AA65 196AA103 196AA159 196AA14 Single Post Ht. Adj - Std (9.75"-14.75" Single Post Ht Adj - Low (8.25"-12.25" Flip Back Ht Adj LITE (10"- Dual Post Flip Back Ht Adj Flip Back Ht Adj Classic (11"- Omit Armrest $341.00 $341.00 9. KEY OPTIONS 196AT1 Anti Tips Anti Tips (Pair $108.00 196A1 1961A01 Pack Accessories Backpack - Black/Charcoal Adult Seat Pouch Black $100.00 $75.00 196A141 196A804 Positioning Belt 1.5" Auto Buckle w/ Clamps Positioning Belt Slide Clamps $87.00 $55.00 10. COLOR 196C140 196C2 196C141 196C10 196C38 196C36 196C14 196C35 196C142 196C143 196C126 196C144 196C147 196C148 196C103 196C114 196C145 196C113 196C8 Standard Frame Colors Aztec Gold Black (Not avail as base w/zebra Black Cherry Black Opal Blue Opal Candy Blue Candy Purple Candy Red Electric Blue Evergreen Glow Green Apple Hot Sparkle Pink Mauve Pink Rootbeer Sparkle Silver Sunrise Orange Titanium Color Paint Yellow Additional Options Through Built for Me To inquire about any unique customization for Quickie products, contact: Phone: (800 263 3390, Fax: (800 561 5834 Page 4

11. APPENDIX Front Seat Height Matrix Cont. Lower Leg Length Range Matrix Page 5

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