RGK Tiga Sub4. July Serial Number: Manufacturing Date:

Similar documents
Serial Number: Manufacturing Date: /20

Serial Number: Manufacturing Date: /20

Serial Number: Manufacturing Date: /20

Serial Number: Manufacturing Date: /20

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

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

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

MASS Script Form. Frame. Backrest. Seat Depth

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

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

Please make your selection with a cross in the box Standard feature Free of Charge

SEATING CHOICE TITANIUM FRONT FRAME

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

k-series Aluminium Standard Features

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

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.

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

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

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

ORDER FORM Ver.9.0 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

Town: Postal code: Town: Postal code: CLIENT MEASUREMENTS. Seat Width in cm 38 cm 40 cm 42 cm 44 cm 46 cm. 40 cm

SEAT BACKREST. REAR SEAT HEIGHT SELECTION: independant of rear wheel size. Rear seat height in cm (2)

champion Standard Base Price 1,875 Standard Features

Condor Script Form Folding Frame Day Wheelchair 90050

Max. user weight: 110Kg / 140kg USER WEIGHT Fax number: +44 (0)

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:

1,795. Base Price. Part no.: CLIENT MEASUREMENTS. Town: Postal code: Town: Postal code: Tel: Fax: Tel: Fax: Purchase order:

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

ORDER FORM Ver.6 Rev DEALER COLOURS INFORMATION For Office Use Only Dealer: Order Date: S/N: Account: P.O.#: RTS Ordered By: RTS: Phone:

Order Date : carbon. Tension adjustable seat, option DDA0611 is not possible with seat width 320mm

Küschall Champion DEALER Maximum user weight 120kg (19 Stone)

YOU RE YOUNG. YOU RE ACTIVE. YOU RE YOU. GROWTH WITH AN EDGE. ROGUE XP.

Küschall K Series DEALER Maximum user weight 120kg ( 19 Stone )

Stallion Script Form Fixed Frame Adjustable Wheelchair 90100

Order Form. English Company stamp. Version mudguard (AVAILABLE ONLY WITH REAR WHEELS 24'') Version straight sideguard

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

Zippie Zone July 2018 EIRZ1

Additional Front Wheel Options Not Shown FW1 3 x.75 Micro-Caster FW14 4 x.75 Plastic Wheel w/poly Tire FW3 4 x.75 Light-Up Micro-Caster

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

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

Condor Script Form Folding Frame Day Wheelchair 90050

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

Quickie Q7 Adjustable March 2014

noir 2.0 Order Form NONO Carbon fibre frame made-to-measure. English Company stamp Date User name Responsible Seat depth (PS)

This wheelchair has a weight limit of 80kg

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

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

Küschall Champion DEALER Maximum user weight 120kg (19 Stone)

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

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

TiLite. Please Fax to the TiLite Customer Service Team at or

Wheelchair Portfolio. Active wheelchair

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:

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

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

Quickie GTX Fixed Frame EIF3, Effective July 2009

Order Date: SHIP TO Name: Address: : City: Phone: PRICEE

Custom Manual Options & ACCESSORIES AUSTRALIA 2013

Voyager Evo. Rigid-frame active wheelchair. Standard equipment. Canada: Fax: Order Form and Price List

Quickie GTX Swing-Away FSS NET ORDER FORM/PRICE LIST (SIN F-1)

The lightest folding wheelchair in the world - now with swing away legrests!

NOT JUST A WHEELCHAIR. A MEMBER OF THE TEAM.

Account Number: Provider Name: Contact:

Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

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

Account Number: Provider Name: Contact:

Dealer Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

COST EFFECTIVENESS THERAPEUTIC BENEFITS APPLICATIONS. the optimal smoothness and lightweight design facilitate the independence of the user

3 A7WC10 E-Motion adaptor Kit (2 adaptors)

Invoice address: same as company address. Invoice address: other (see below) Cust. no.: Name: Street: Postcode, city: Phone: Fax: Contact:

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

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

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

SPEEDY 4all "Classicline"

lightweight-rigid for handling and performance

HELIUM NEXT GENERATION STYLE

RESIST CONFORMITY. GO ROGUE.

BEARINGS BEARINGS

4.8. A6MA085 Italian Manual. 3" caster 4" caster. 8" caster Stem bolt Length. + 2,54 cm 1" + 5,08cm 2" STD. 36,8cm 14,5" 34,3cm 13,5" 39,4cm 15,5"

Quickie QX July 2017

Helio A6 ORDER FORM - CANADA

Order Form. English Company stamp

Black -01 Moss green -95 Yellow -99. Heather purple -97. Indicate height. Indicate height. Indicate angle. Indicate height: cm. Indicate height: cm

The lightest folding wheelchair in the world

Helio A6 ORDER FORM - CANADA

Order Date : k-series. titanium. Please make your selection with a cross in the box Standard feature Free of Charge

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

4.8. Name: K0005. Stem bolt Length /2 15 1/2 16 1/ /2 15 1/2 16 1/ /2 16 1/2 17 1/2

Quickie QX December 2018

C2 FRONT Seat-to-floor Height - Please select your choice. Custom Technologies Limited. 40 Raywood Crescent TAUPO. New Zealand

4.8. Clinician/ATP/RTS: City: State/Prov: Marked for: Phone: * Required KDMA063 English Manual (STD) Manuel Français

MODEL ZX1 CHARACTERISTICS, POTENCY AND BENEFITS

UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY.

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

IT S NOT IMAGINARY. IT S REALITY. BRINGING YOU LITTLE WAVE.

Auftrags-Nr.: Order no.: ... Date Signature. MA 110 Standard

BUDDY "Classicline" Active easy running wheelchair

Etac Cross 5 and Cross 5 XL

4.8 MODEL WM / /2 15 1/2 16 1/ /2 15 1/2 16 1/ /2 16 1/2 17 1/2

Transcription:

Manufacturing Date: Sunrise Medical Head O ce: 237 Romina Drive, Unit 3 Concord, ON L4K 4V3, Canada Telephone: +1.800.263.3390 Fax:+1.800.561.5834 E-Mail: cscanada@sunmed.com www.sunrisemedical.ca RGK Tiga Sub4 July 2018 Distributor Name: Contact Name: Dealers Name: Client's Name: Address: Client's Weight: Postal Code: Client's Height: Country: Client's Disability: Telephone: Email: Notes/Coents: Purchase Order No: Delivery Address: Postal Code: Contact Name: Telephone: Email: FOR RGK OFFICE USE ONLY Distributor: Net Value: $ A/C No: Freight: $ Who Date Invoice Value: $ OK to Quote: Payment Received: $ OK to Con rm: Document No: DOC Page 1 of 9

Base product Mandatory informa on Informa on required for op on Standard con gura on Op on with no extra cost Op on with extra cost SBAXZ010 $ 7,210.00 TIGA Sub4 A7020 XA070 Frame open design Max User Weight 110kg XW010 NC KEY FRAME MEASUREMENTS XY010 Seat width (Inside of sideguards) (Max - 440) (Min - 250) XY020 Seat length (Max - 440) (Min - 250) XY030 Seat frame addi onal length (Provides additional leg support & hand grip) (Max - 440 total seat) XY050 Front frame height (Max - 520) (Min - 380) XY060 Rear frame height (Max - 500) (Min - 360) XY070 Frame length (Min = XY020 + XY030 + 110) (Max - 625) XA020 $ 96.00 Frame ergonomic seat Specify length (Standard = 120) Page 2 of 9

XY080 Front seat taper design FRONT FRAME AND FOOTREST Front Frame Op ons Footrest width Specify width Specify width (Optional, to provide additional leg support / positioning) (When combined with XY080, dimensions must be smaller) XY100 Footrest round design (Minimum 60) Footrest Design & Measurements (Choose One) XY105 Footrest square design (Square design allows higher position) (Minimum 60) Please indicate front footrest height: Please indicate front footrest height: 60 80 100 120 60 80 100 120 Individual Individual Castor Wheel Size 4" Max Height Achievable 110 Castor Wheel Size 4" Max Height Achievable 130 Rear footrest height Footrest Individual Measurements O mize measurements (Std = Footrest height - 20) Footrest length Maximum length 140 XB010 XB045 O mize measurements (Std = 100) Footrest height adjustable lightweight tubular aluminium Footrest cover lightweight carbon Footrest Style Footrest Cover Page 3 of 9

CASTOR WHEELS, FORKS & WHEEL LOCKS Castor Wheels XC135 Castor wheel 4x1.25" aluminium centre with urethane re frog legs Choose colour below: Silver hub & black re (Std) Black hub & black re Purple hub & black re Green hub & black re Red hub & black re Blue hub & black re XC190 Castor fork low ride daily use Castor Forks Black Silver XY330 Castor pin width Op ze measurements (Minimum width for clear castor rotation and maximum wheelbase length) Castor Pin Width Wheel Lock ns SBAXD036 Wheel locks compact scissor with XD010 lightweight xing Wheel locks omit Sideguard Carbon Fibre ns SIDEGUARDS Sideguard with Fender Carbon Fibre ns XE055 Sideguards screw on lightweight carbon re XE065 Sideguards screw on lightweight carbon bre with fender Sideguard Measurements ized measurements Sideguard Measurements ized measurements Sideguard individual above re (Follow tire) max 25 Sideguard level with re (Follow tire) Fender sideguard height above re (Min = 10) Op ze 10 above re (Std if not indicated) Fender sideguard to centre of re Page 4 of 9

Backrest Height - Fixed BACKREST Backrest Design - Fixed Backrest height xed Specify height XG010 Backrest xed (Non-folding) XY360 Backrest angle -5-3 0 +3 +5 Ergonomics - Rearward Posi oning (Choose One) XG100 Backrest ergonomic $ 116.00 Ver cal height (Min 250) Individual Deg (Max -10/+20 Deg) Rearward posi on Ergonomics - Lateral Posi oning (Choose One) XG110 Backrest inward taper XG120 $ 116.00 (Above sideguards) $ 116.00 Backrest outward are (Above sideguards) Width Width Specify Camber Angle CAMBER BAR Fixed Centre of Gravity XY390 Camber angle 1 2 3 SBAXH100 Camber bar xed posi on welded into frame single post (25-125) FRAME FINISH OPTIONS Frame and Footrest SBAXN030 Finish frame brushed SBAXN050 Finish frame polished Accent Colour (Choose One) Finish accent colour black Finish accent colour silver Finish accent colour red Finish accent colour blue Finish accent colour purple XP045 XP035 Upholstery seat sling Sub4 adjustable tension Upholstery backrest Sub4 adjustable tension UPHOLSTERY Seat Upholstery Backrest Upholstery Silver (Standard if not indicated) Red Backrest Upholstery S tching Op ons Black Light blue Other Upholstery Blue Purple XS065 Accessory lightweight Calf Strap Page 5 of 9

REAR WHEELS (* non certi Wheel Size d weight options) XY420 Wheel size 24" XY430 Wheel size 25" Wheel Gap XY460 Rear wheel gap 15 20 25 XK225 Wheel tanium quick release axle pin (pair) Wheel Op ons Spinergy Colour Options Black spoke / Black hub White spoke / Black Hub XK180 Spinergy spoke colour custom $ 170.00 (Specify below) Red spoke / Black hub Blue spoke / Black hub Colour inside XK075 Yellow spoke / Black hub Green spoke / Black hub Colour outside Wheel Spinergy BLXL 18 blade spoke daily, rivnut handrim moun ng (select colour below - Note: Black hub only) Pink spoke / Black hub Orange spoke / black hub Note: Supply picture for custom designs XK040 Wheel omit / supply without $ (212.00) (Specify wheel type / size / tyre) Handrim set narrow (Standard if no option selected) Handrim Posi on Handrim Op ons Handrim set wide XL010 Handrim aluminium hard anodized 6 tab (Lightest Op on) XL040 Handrim tanium 6 tab (Standard if no option selected) $ 355.00 XL030 Handrim surge LT 6 tab XL050 Handrim stainless steel 6 tab $ 499.00 $ 197.00 XL020 Handrim tetra grip 6 tab XL090 Handrim remove excess moun ng tab $ 318.00 $ 116.00 (Recoended when XY460 is 20 or XL100 Handrim para grip 6 tab less) (Narrow set only) $ 318.00 Tire Op ons XM060 $ 106.00 XM010 XM130 $ 22.00 XM020 $ 79.00 XM040 $ 128.00 Tire Schwalbe One (Lightest op on) Kenda Tire High Pressure Kenda black Tire Schwalbe Marathon Plus Tire Shox solid airless black only (24",25" only) Grey (Standard if no option selected) XM050 $ 32.00 Inner Tube Valve Op ons Blue Red Tire Kenda K885 mountain bike re (24",25" only) XY500 Schraeder inner tube valve (Standard if no option selected) XY490 Presta inner tube valve * Indicates items that are not part of the cer d weight of the Tiga Sub4 Page 6 of 9

CUSHION (** non certi ed weight options) XP080 $ 96.00 Upholstery cushion foam with nylon cover Cushion foam so Cushion foam medium Cushion foam hard (CMS040) (CMS050) (9 lbs. recon) Cushion thickness 50 Cushion thickness 75 Cushion thickness 100 XP090 $ 79.00 XP100 $ 202.00 Upholstery cushion cover upgrade to Air Lite Upholstery cushion cover upgrade to leather Leather colour black Leather colour red Leather colour grey FRAME OPTIONS (** non certi ed weight options) XR060 Accessory welded calf strap moun ng loops $ 122.00 (To locate calf strap on front frame) XR080 $ 838.00 Accessory frontwheel assembly (Only with XB010, TGAXB080, XB150) Frontwheel serial number (O ce use only) ACCESSORIES (** non certi ed weight options) XP120 $ 67.00 Upholstery frame protectors neoprene zip fasten with TIGA logo (Nylon with velcro fasten with XR060) XR010 $ 47.00 Accessory seat pouch velcro a ach (Black) XR020 Accessory large underseat storage bag (Black) $ 101.00 XR090 Accessory toolkit ** indicates op ons that, when chosen, will not enable RGK to guarantee a Sub4kg product weight Page 7 of 9

XB200 Footrest with high level riser system Please indicate front footrest height: $ 160.00 XC150 $ 185.00 Castor wheel 3x1.4" aluminium centre frog legs (Silver hub and black urethane tire) OTHER (** non certi ed weight options) Footrest Castor wheels 3 and 5" XC070 Castor wheel 5x1.3" so roll black XC100 $ 197.00 XC120 $ 185.00 XC140 $ 185.00 Castor wheel 5" pneuma c aluminium centre Castor wheel 5x1" aluminium centre frog legs (Silver hub & black urethane tire) Castor wheel 5x1.4" aluminium centre frog legs (Silver hub & black urethane tire) Wheel Lock Op ons XD020 Wheel locks underseat scissor XD050 Wheel locks push to lock Sideguards XE030 Sideguards screw on aluminium, indicate size on page 4 $ 260.00 SBAXG020 $ 304.00 XG070 $ 180.00 Backrest Op ons Backrest folding with 2 posi on snap lock and angle adjust Push handle Op ons Backrest with screw in push handles (N/A XG080 with XY245) $ 350.00 Backrest with p down push handles An -Tip Op ons XJ100 $ 402.00 XP040 An p single sport Upholstery seat sling adjustable tension with straps Seat Upholstery XR050 $ 382.00 Accessory carbon bre seat plate in lieu of seat upholstery Backrest Upholstery XP050 Upholstery backrest Airtech adjustable tension with straps XP070 $ 96.00 Upholstery upgrade to leather corners on side wings - (N/A with XG080) Leather colour black (Standard if not Indicated) Silver (Standard if not indicated) Backrest Upholstery Leather Op ons (only with XP050) Leather colour red Backrest Upholstery S tching Op ons (only with XP050) Black Leather colour grey Blue Red Light blue Purple Backrest Upholstery Logo Op ons (only with XP050) Silver Black (Standard if not indicated) Blue Red Light blue Purple Backrest Accessories (only with XP050) XP110 Upholstery backrest with zip fasten pocket XP170 Upholstery with individual embroidery $ 101.00 $ 160.00 (Please provide.jpeg e and positioning) ** indicates op ons that, when chosen, will not enable RGK to guarantee a Sub4kg product weight Page 8 of 9

NOTES Page 9 of 9

2024 © autodocbox.com Privacy Policy | Terms of Service | Feedback