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

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Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription form Pencoed. CF35 5AQ LPF1U2CHAMPION011113D Tel: 01656 776222 Fax: 01656 776220 LPF0015X email: ordersuk@invacare.com January 2014 For up to date spare parts online, please visit www.invacare.co.uk Customer Name : Account No : Dealer : Address : Order No : Order Qty : Tel No: Delivery address : Order Date : Küschall Champion DEALER Maximum user weight 120kg (19 Stone) Standard Features: Active, Lightweight, Folding Aluminium 75 Frame Choice of 7 Seat Widths 360mm - 460mm (14" - 18") Choice of 7 Seat Depths 340mm - 460mm (13" - 18") Angle Adjustable Folding Backrest with Nylon Light Upholstery and Standard Push Handles Angle Adjustable Flip Up Footrest with Calf Strap Flip up Carbon Clothesguards 5" Comfort Front Castors with Black Tyres Kuschall Starec Q/R Rear Wheels with Light Pneumatic Tyres and Aluminium Handrims Standard Brake Lever Bent Choice of 14 Frame Colours Standard Base Price: 2,015 Please make your selection with a cross in the box Standard feature Free of Charge Customer weight = Kg Code X Description Dealer DDF0031 küschall Champion 2,015 DDF0000 MY Kuschall Special Construction Fill in all information at the end of the order form P.O.A. SEATING CHOICE FRAME (On Dynamic, Active and Carbon frames, seat depths below 420mm are not compatible together with Dynamic adapter in 1st position and Active brakes DDF0203 Active frame, aluminium 75 DDF0212 Dynamic frame, aluminium i 90 (NC: 0820,0821) 0821) DDF0201 Adduction frame aluminium 75 (NC: 0126,0128,1714) 155 DDF0243 Adduction frame aluminium 90 (NC: 0126,0128,1714) 155 Titanium frame includes a carbon fibre castor fork supporter DDF0287 Titanium frame 75 799 DDF0292 Titanium frame 90 799 Carbon frame 85 (600g weight saving) (NC: 0410,0412,0415) DDF0204 (In natural colour only, minimum knee to heel 300mm required) (NC: 0417 with 0263) 450 SEAT WIDTH (SB) DDF0126 DDF0128 DDF0130 DDF0132 DDF0134 DDF0136 SEAT DEPTH (ST) DDF0410 DDF0412 DDF0415 DDF0417 DDF0419 DDF0421 DDF0424 SW 360 mm SW 380 mm SW 400 mm SW 420 mm SW 440 mm SW 460 mm SD 340 mm SD 360 mm SD 380 mm SD 400 mm SD 420 mm SD 440 mm SD 460 mm BACK HEIGHT (RH) DDF0550 RH 300 mm DDF0503 RH 315 mm DDF0506 RH 330 mm DDF0509 RH 345 mm DDF0512 RH 360 mm DDF0514 RH 375 mm DDF0516 RH 390 mm DDF0518 RH 405 mm DDF0520 RH 420 mm DDF0522 RH 435 mm DDF0524 RH 450 mm DDF0526 RH 465 mm (NC: 1491,0700) (NC: 1491,0700) 1 of 7

FRONT SEAT-TO-FLOOR HEIGHT (SHv) With Dynamic frame, front seat height is 10mm higher than stated below DDF0847 FSF 450 mm DDF0848 FSF 460 mm DDF0849 FSF 470 mm DDF0850 FSF 480 mm DDF0851 FSF 490 mm DDF0852 FSF 500 mm DDF0853 FSF 510 mm DDF0854 FSF 520 mm DDF0855 FSF 530 mm DDF0856 FSF 540 mm REAR SEAT-TO-FLOOR HEIGHT (SHh) DDF0944 RSF 390 mm DDF0945 RSF 400 mm DDF0946 RSF 410 mm DDF0947 RSF 420 mm DDF0948 RSF 430 mm DDF0949 RSF 440 mm DDF0950 RSF 450 mm DDF0951 RSF 460 mm DDF0952 RSF 470 mm DDF0953 RSF 480 mm DDF0954 RSF 490 mm KNEE-TO-HEEL LENGTH (UL) UL has to be a minimum of 30mm less than Front seat height. On Aluminium frame UL 220mm - 310mm is upmounted. On Carbon frame UL 300mm - 340mm is upmounted. UL measurment excludes cushion and must be a minimum of 3 cm less than Front Seat Height DDF1663 UL 220 mm DDF1664 UL 230 mm DDF1665 UL 240 mm DDF1666 UL 250 mm DDF1667 UL 260 mm DDF1668 UL 270 mm DDF1669 UL 280 mm DDF1670 UL 290 mm DDF1671 UL 300 mm DDF1672 UL 310 mm DDF1673 UL 320 mm DDF1674 UL 330 mm DDF1675 UL 340 mm DDF1676 UL 350 mm DDF1677 UL 360 mm DDF1678 UL 370 mm DDF1679 UL 380 mm DDF1680 UL 390 mm DDF1681 UL 400 mm DDF1682 UL 410 mm DDF1683 UL 420 mm DDF1684 UL 430 mm DDF1685 UL 440 mm DDF1686 UL 450 mm DDF1687 UL 460 mm DDF1688 UL 470 mm DDF1689 UL 480 mm DDF1690 UL 490 mm DDF1691 UL 500 mm BACKREST BACK UPHOLSTERY DDF0700 Standard light upholstery (NC: 0750,0703,1491) DDF0722 Nylon upholstery with tension adjustable back Black/Grey 100 DDF0735 Aero upholstery with tension adjustable back PUSH HANDLES DDF0750 Without push handles DDF0702 Standard push handles DDF0703 Height adjustable rear set 185 DDF0704 Foldable push handles 144 DDF0733 Height adjustable, integrated 160 2 of 7

BACK ANGLE DDF0713 DDF0714 DDF0715 DDF0716 DDF0717 BACKREST OPTION DDF1491 Backbrace (swing away and removable) 91 SEAT UPHOLSTERY DDF0610 DDF0600 küschall seat cushion, 8cm foam with Visco top layer 48 DDF0606 Seat bag, click in and removable, includes the fixation clips (DDF1714) 53 FOOTREST DDF1500 DDF1501 DDF1533 DDF1535 DDF1401 Carbon clothes guards flip back DDF1408 Carbon mud guards, removable (NC: 1416) 205 DDF1416 Armrest height adjustable, short 70 DDF1411 Tubular height adjustable removable and swing away comfort padded 176 DDF0300 DDF0354 DDF0302 DDF0303 DDF0350 DDF0314 DDF0315 DDF0356 79 83.5 88 92.5 97 Standard CUSHION AND SEAT OPTIONS CALF STRAP SIDE GUARDS ARMREST FRAME COLOUR Flip-up footplate set to the front Flip-up footplate set to the rear Mounted on supporter Mounted on frame Glossy-Black Night Shimmer Royal Blue Royal Red Purple Fire Black Matt Silver Grey Ivory White DDF0357 Umber glaze DDF0358 Smokey grey DDF0359 Flashy yellow DDF0363 Black-grey rustico DDF0364 Golden beach FRAME COLOUR, POLISHED DDF0310 Mirror Natural 193 COLOUR-POWER-SET Small colour shade differences are possible DDF0330 Colour-Power-Set techno-anthracite DDF0334 Colour-Power-Set b-blue DDF0329 Colour-Power-Set comet red DDF0336 Colour-Power-Set artic blue DDF0337 Colour-Power-Set copper glaze DDF0338 Colour-Power-Set chrome DDF0339 Colour-Power-Set champagne DDF0340 Colour-Power-Set olive 3 of 7

FRONT WHEEL Please note: 5" castors are not compatible with Dynamic 90 degree frame or with the carbon 85 degree frame in combination with footplate set to back DDF0800 75mm (3") Supersport DDF0801 100mm (4") Everyday wheel, black tyre DDF0824 100mm (4") Skater wheel DDF0803 100mm (4") Starec techno-anthracite DDF0807 100mm (4") Starec b-blue DDF0808 100mm (4") Starec comet red DDF0830 100mm (4") Starec copper glaze DDF0831 100mm (4") Starec artic blue DDF0809 100mm (4") Starec black DDF0861 100mm (4") Starec chrome DDF0825 100mm (4") Starec champagne DDF0826 100mm (4") Starec olive DDF0810 125mm (5") Light wheel, black tyre DDF0863 125mm (5") Comfort Wheel black rubber DDF0813 125mm (5") Starec techno anthracite DDF0817 125mm (5") Starec b-blue DDF0818 125mm (5") Starec comet red DDF0833 125mm (5") Starec copper glaze DDF0832 125mm (5") Starec Artic blue DDF0819 125mm (5") Starec black DDF0862 125mm (5") Starec chrome DDF0827 125mm (5") Starec champagne DDF0828 125mm (5") Starec olive DDF0820 150mm (6") Light wheel, black tyre DDF0821 150mm (6") Pneumatic wheel REAR WHEEL POSITION DDF0261 Dynamic Adaptor Plate (NC:0916) 1st Position (N/C on aluminium frame with seat depths less than 420mm in combination with active brakes) DDF0263 (N/C on carbon frame with seat depths less than 440mm in combination with active brakes) DDF0264 2nd Position (N/C on carbon frame with seat depths less than 420mm in combination with active brakes ) DDF0262 DDF0264 DDF0265 DDF0266 QUAD RELEASE AXLE Active Adaptor Plate DDF0909 Quad Quick Release Axle 62 REAR WHEEL SIZE DDF0901 559mm (22") (NC: 0906,0908,0916,0913,0918) DDF0902 609mm (24") DDF0925 635mm (25") (NC: 0915,0916,0908,0913,0918,0906) DDF0903 660mm (26") (NC: 0906,0908,0916,0918) REAR WHEEL CAMBER DDF0282 0 Degree Camber DDF0283 4 Degree Camber (NC: 1302,0916) REAR WHEEL TYPE 559mm (22"), 609mm (24"), 660mm (26") küschall Starec wheels DDF0915 (Colourless Starec hub or in CPS if selected) DDF0908 609mm (24") High Performance wheel (Starec hub black or in CPS if selected) (NC: 0910,0911,1004,1006,1007) 182 (NC: 0910,0911,1001,1002,1004,1006,1007,1102, DDF0918 635mm (25") High Performance wheel (Starec hub black or in CPS if selected) 1104,1106,1200,1202) 266 (NC: 0910,0911,1001,1002,1004,1006,1007,1010, DDF0913 609mm (24") Mountain Bike with specific tyre 1011,1104,1106,1120,1202) 164 DDF0906 609mm (24") Spinergy LXK wheel No Spokeguards available (NC: 0910,0911,1104,1200,1202) 421 TYPE OF SPOKES DDF0910 DDF0911 2nd Position 3rd Position 4th Position Cross spoked Radial spoked (N/C on carbon frame with seat depths less than 420mm in combination with active brakes (NC: 0916) E-MOTION ADAPTATION (adaption plate and Alber anti tippers included - does not include e-motion wheels) E-Motion adaptor plate (Only available with 24" wheels 0 Deg camber) DDF0916 Refer to Alber order form for details on wheels (NC: 1702,1703,1704,1706,1707) 188 4 of 7

REAR WHEEL TYRE DDF1001 559mm (22"), 609mm (24"), 660mm (26") Light wheel 7 bar, DDF1002 559mm (22"), 609mm (24") Profile tyre 7 bar DDF1004 609mm (24") Solid tyre with profile, grey 48 DDF1006 609mm (24") Solid tyre (KIK-tyre), black 63 DDF1010 609mm (24") 635mm (25") Black Marathon Evolution tyre with kevlar lining 73 DDF1007 559mm (22"), 609mm (24") Solid tyre Light wheel, grey 48 DDF1011 609mm (24"), 635mm (25") Schwalbe Ultremo ZX tyre 62 ANTI-FLAT DDF1020 Anti-flat tyre tube protection 15 HANDRIM DDF1102 559mm (22"), 609mm (24"), 660mm (26") Supergripp, dist. 30mm 145 DDF1104 609mm (24"), 660mm (26") Steel polished, dist. 30mm 45 DDF1106 609mm (24") Titanium dist. 30mm 128 DDF1120 609mm (24"), 635mm (25"), Surge LT 30mm, 3cm distance 237 DDF1113 559mm (22") 609mm (24"), 635mm (25"), 660mm (26") Light Alu dist. 30mm DDF1114 559mm (22") 609mm (24"), 635mm (25"), 660mm (26") Light Alu dist. 40mm SPOKE GUARDS DDF1200 Transparent 85 DDF1202 609mm (24") Küsch 85 FIXATION STRAP DDF1714 Fixation strap (Holds frame together in closed position) UNFOLDING HELP DDF1719 Unfolding help (To open folding mechanism from front) SAFETY BRAKES DDF1300 Standard brake, lever bent DDF1301 Standard brake, lever straight DDF1306 Pull Brake 55 DDF1302 Performance brake 55 DDF1303 Active brake 55 BRAKE EXTENSION LEVER DDF1310 Brake extension lever (For straight lever brakes only) 32 ANTI-TIPPER TIPPER NB: maximum of two rear frame adaptions per side DDF1702 Anti-tipper right DDF1703 Anti-tipper left DDF1704 Anti-tipper both sides 92 SEAT BELT DDF1730 Seat belt 54 ACCESSORIES DDF1745 Bottle holder with bottle 20 DDF1746 Mobile phone holder 20 DDF1739 Front frame protectors 24 TIPPER AID DDF1708 Tipper-Aid, right (NC: 1706) 33 DDF1709 Tipper-Aid, left (NC: 1707) 33 DDF1720 Tipper-Aid, both sides (NC: 1706,1707,1721) 66 CANE HOLDER DDF1706 Cane holder, right 54 DDF1707 Cane holder, left 54 DDF1721 Cane holder, both sides 108 TRANSIT WHEELS NB: maximum of two rear frame adaptions per side DDF1700 Transit wheels 75mm (3") 151 PUMP DDF1715 Air pump 10 KÜSCHALL WATCH (Mounted in Castor Housing) DDF1712 Watch Right side (NC: 1713) 77 DDF1713 Watch Left side (NC: 1712) 77 TOOL KIT DDF1717 Tool kit PRICE TOTAL PRICE 5 of 7

Frame / Possible UL * Aluminium UL: 32-50 cm UL: 22-31 cm high mounted * Carbon UL: 40-50cm UL: 30-34 cm high mounted * Titanium UL: 36-50 cm UL: 22-34 cm high mounted Adapterplate position Dynamic adapterplate Active adapterplate Rear wheel size/rsf Backrest Angle 22" : 39-44 cm 24" : 39-47 cm 25": 41-49 cm 26" : 42-49 cm Non Conforming Items Guide DDF0126 Seat width 360mm DDF0128 Seat width 380mm DDF0263 Rear Wheel Position 1st from front DDF0410 Seat depth 340mm DDF0412 Seat depth 360mm DDF0415 Seat depth 380mm DDF0417 Seat depth 400mm DDF0700 Standard Upholstery DDF0703 Height adjustable push handles DDF0750 Without Push Handles DDF0820 6" Light wheel DDF0821 6" pneumatic wheel DDF0906 24" Spinergy LXK wheels DDF0908 24" High Performance Wheels DDF0910 Cross spoked DDF0911 Radial spoked DDF0913 24" Mountain Bike wheel DDF0915 22", 24", 26" Kuschall starec wheels DDF0916 E Motion adapter plate DDF0917 24", 25" Spinergy Wheels DDF0918 25" High Performance Wheels DDF1001 Light Wheel 7 bar DDF1002 Profile tyre 7 bar DDF1004 24" Solid tyre with profil, grey, DDF1006 24" Solid tyre (KIK-tyre), black, DDF1007 Solid tyre Light wheel, grey, 22", 24" DDF1010 Marathon evolution tyres DDF1011 Schwalbe Ultremo ZX tyres DDF1020 Anti-flat tyre tube protection DDF1102 Supergrip handrim DDF1104 Steel polished, 24", 26", dist. 3 cm DDF1106 Titanium handrim DDF1120 Surge LT Handrim DDF1200 Transparent spokeguards DDF1202 24" Kuschall spokeguards DDF1302 Performance brakes DDF1303 Active Brakes DDF1416 Siderest height adjustable short DDF1491 Backbrace DDF1533 Mounted on supporter DDF1702 Anti tipper RH DDF1703 Anti tipper LH DDF1704 Anti tipper both sides DDF1706 Cane holder, right DDF1707 Cane holder, left DDF1712 DDF1713 DDF1714 DDF1721 Watch right side Watch left side Fixation strap Cane holder both sides 6 of 7

Special Instructions: Please supply the following information Name: Email: Phone: Description of special request (please include relevant option code): 7 of 7

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