Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.

Similar documents
Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.

Page 1 of 13 INTRODUCTION PATIENT INFORMATION

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight:

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight:

Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA Sales: Phone: (866) Fax: (866)

Q6 Edge 2.0 Order Form with Pediatric TRU-Balance 3 Positioning - Group 3

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight:

Quantum 600 Series Group 3 Single Power & Multiple Power Order Form/ODJFS Only 300 lbs. weight capacity. Revised: December 13, 2012 Page 1 of 7

Q6 Edge HD Order Form with TRU-Balance 3 Positioning - Group 3, ODJFS Only

Q6 Edge Z Order Form with Contoured and Synergy Seating - Group 3

Q6 Edge 2.0 Order Form with TRU-Balance 3 Positioning - Group 3

Quantum R4000 Series Group 3 Single Power & Multiple Power Order Form / ODJSF Only 300 lbs weight capacity

Q6 Edge Z Order Form with TRU-Balance 3 Positioning - Group 3, ODJFS Only

Quantum Rehab A Division of Pride Mobility Products Corporation

Q6 Edge 2.0 Order Form with TRU-Balance 3 Positioning - ODJFS Only

Quantum Q1121 Series Group 3 Single Power and Multiple Power Order Form 300 lbs. weight capacity

Quantum R4000 Series Group 3 Standard Order Form 300 lbs. weight capacity

1. BASE MODEL REQUIRED.

Quantum 1103 Ultra Series Group 2 Single Power Order Form 200 lbs weight capacity

Velocity Order Form. Dealer Information Dealer Name ATP Account Number Phone Fax Date PO# Ship to Address City State Zip

Quantum 1103 Ultra Series Group 2 Static Seating Order Form 300 lbs. weight capacity

Quantum 600 XL (HD)Series Group 3 Heavy Duty Order Form 400 lbs. weight capacity

M1 - NPO. Dealer Information. Client Information. Client Measurements

ORDER FORM EIPW25. with CAPTAIN'S SEAT. Print pages 1-10 to exclude pictures. Buyer State Zip

Q6 Edge Z Order Form with TRU-Balance 3 Positioning - Group 3

Positioning Components Order Form - ODJFS Only

Q6 Edge 3 Order Form with Contoured, Synergy, and TRU-Balance Flex Seating

Canada Quote / Order Form Combi

Q6 Edge 2.0 Order Form with Contoured, Synergy, and TRU-Balance Flex Seating

Q6 Edge 2.0 Order Form with Contoured and Synergy Seating - Group 3

Q6 Edge 3 Order Form with Contoured, Synergy, and TRU-Balance Flex Seating

Quantum 4Front Order Form with TRU-Balance 3 Positioning

FUZE T50. Order Form USA. Please send your completed order form by to or by fax to

AT MSRP Price List. Description. HCPCS Code K0020 K0020 K0106 K0106. Part Number AP3 AP4 GAP GAPS 1386/87 FUA PT0031

C300 Corpus Tilt. Please send order/quote to fax#: (800) to: * Indicates a Required Field Dealer Information

For AADL Only AADL Cat. #W558

Q6 Edge HD Order Form with Contoured and Synergy Seating

Quantum 1450 Order Form with Contoured and Synergy Seating

Pride Mobility Products Australia Pty Ltd Apollo Drive Hallam, VIC, 3803 Sales: Phone: (03) Fax: (03)

FUZE T50. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e

STELLAR GL. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

STELLAR. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Traxx 3 & Atigra 2 Script Form

BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

JIVE F/R: 5,650 9,193 JIVE M: 5,895 9,591

Specifications are subject to change without notice. 2018, Amylior Inc. (March 2018) AMYSEAT (Rev.0) Page 1 of 7

Vision Ultra-single power

Invacare Kite (Modulite Flex3 Seating System) Dealer Max User Weight 160Kg (25 stone)

Standard Base Price : 2,950. Standard Features

Adjustable Height Raised Toilet Seat Model 101 RTS Pricelist/Order Form December 2014

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models:

Bora. Standard Base Price 4,100. Standard Features SEAT DEPTHS

Account Number: Provider Name: Contact:

FUZE T20. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

For the Modulite Teen seating please select the underlined options on this form and include a completed Modulite Teen Seating form

Account Number: Provider Name: Contact:

The order form has (MSRP) retail prices, but your price is at least 25% less than retail price. Multiply retail by.75 or call or for a quote.

USA CANADA.

ULTRA TDX 2. Retail Order Form Max user weight 136kg (21.4 stone) Featuring

Invacare TDX Series with Tilt

Featuring. Customer Ref: TDX2 Ultra

V6 & X8. Table of Contents

Quickie QM-7 Series. Live Without Limits. Available in Eight Group 3 and Group 4 Models:

A lot of life happens at eye level.

SHIPPING INFORMATION Provider Acct #:

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

NAME PHONE NO ACCOUNT # P.O. DATE ADDRESS

SHIPPING INFORMATION Provider Acct #:

The maximum standard user weight capacity is 300 lbs (For Invoicing, if Different then "Ship To" Location)

SALSA M. Salsa MWD. Base Price 4,733 STANDARD SEAT: FRAME / SEAT SIZE STANDARD SEAT: CUSHION JAY CUSHIONS JAY COMFORT SEAT

SHIPPING INFORMATION Provider Acct #: Address: ST: ZIP:

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

Dedicated to revolutionising the power chair experience. quantumrehab.com

JIVE M2 SEDEO ERGO... 5 SHROUDS... 5 CHASSIS... 5 COLOURED SHROUD ELEMENTS... 6 BACK... 37

Convaid Trekker 2 - HCPCS E1234 Retail Price List / Order Form

R82 Stingray. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: City/State/Zip: Effective: 2/01/ Rev 7.

R82 Kudu - E1233. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features:

R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

Convaid Trekker 2 - HCPCS E1234 Canadian Retail Price List / Order Form

Options and Accessories

BEARINGS BEARINGS

Frame Width. Seating Setup. q 16 q 15 q 14 q 17 q 16 q 15 q 14 Short q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14

R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

Synthesis Tilt Recliner Model: V4

Invacare Action 3 NG Transit Retail Max User Weight 125Kg (19.7 stone)

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

x:panda, size 1, med. back X c x:panda, size 1, med. seat 7¼" X c

Invacare Storm4 Easy Adapt Retail Max User Weight 150kgs (23.5 stone) Standard Features

Invacare Kite (Max Seating System) Retail Max User Weight 160Kg (25 stone)

SpectraXTR2 HD (Modulite Flex 3 Seating or MAX System) Dealer Max User Weight 160Kg (25 stone)

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

M1 - NPO. Please send order/quote to fax#: (800) to: * Indicates a Required Field Dealer Information

ATP MOBILITY ASSESSMENT FORM

ZIPPIE SALSA R2 - CHASSIS

R82 Stingray - E1233

[ ] Quote [ ] Order. Junior US Retail Price List. Account Information. Ship To Information. Standard Features.

Orderform UK / IR Valid from Version 2.1 LUCA QLASS. Date:

Transcription:

AADL W659/W991 Quantum Q6 Edge Z with TB3 Power Positioning FOR AADL USE ONLY Pride Mobility Products Co. 5096 South Service Rd, Beamsville, ON, L0R 1B3 Phone: 888-570-1113 Fax: 866-514-1303 Discount: Terms: Freight: Taken By: Account Number: Provider Name: Contact: Phone: Fax: Email: Date: PO#: Marked For: Ship to Address: City: Prov: PC: For Quantum Use: Note Section For Provider Use: Set-to-Spec This section must be filled out, otherwise the selection will default to the mid-range measurements. Provide back height, armrest height, center mount height and legrest height. Set Back Height: Set Armrest Height Left: Right: Set Center Mount Length: Set Legrest Length Left: Right: Height: Weight: A. Shoulder Width B. Chest Width C. Hip Width D. External Knee Width E. Maximum Sitting Height F. Shoulder Height G. Axilla Height H. PSIS Height I. Trunk Depth J. Ischial Depth K. Thigh Depth L. Lower Leg Length M. Elbow Height 1 September 1, 2016

Base Model Quantum Q6 Edge Z $8,080 300 lbs. wt capacity. Comes standard with 6 mph programmable motors, 8 amp off board charger. Dimensions of base without legrests are 26 W x 35.6 L. Metallic Colors: Back in Black Midnight Blue Base Mounted Foot Platform (Not available with center mount foot platforms) No Foot Platform 14 Run Flat 14 Pneumatic Group 24, 70 Amp No Batteries Installation: Batteries Installed Do Not Install Colors Base Mounted Foot Platform Drive Wheels Batteries LED Light Package Through Q-Logic 2 EX or NE+ 8-Key w/ Lights Not covered by AADL $835 Non-Expandable Controls 4 W Flat Free, Knobby, Extended Traction Tires 1 $400 4 W Pneumatic, Knobby, Extended Traction Tires 1 $400 1. Increases overall base width by 1.5 (3.81cm) Motor Package Motor Upgrades $415 ea. Programmable speed up to 6 Miles per Hour High Speed Motor Package Not covered by AADL $160 Programmable speed up to 8 Miles per Hour; High Speed Motors decrease per-charge range. Accu-Trac Motor Technology $630 Programmable speed up to 6 Miles per Hour; Delivers Enhanced Traction and Tracking, Especially with Switched Drive Controls. Requires Q-Logic 2 EX. 75 Amp NE+ 6-Key For up to 2 Actuators through joystick 75 Amp NE+ 8-Key For Lights 2 September 1, 2016

Expandable Controls Q-Logic 2 EX Joystick $620 Q-Logic 2 EX Joystick For Lights $620 Q-Logic Color Shroud Options: Black Soft Touch Matching Non-Matching Joystick Color Shroud: $75 Not covered by AADL Midnight Blue Stand Alone Joystick with External Charger Port $410 Features: Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction w/ enhanced display for up to 5 profiles. Auxiliary functions including Bluetooth Mouse and IR. Q-Logic 2 Enhanced Display Kit $1,945 Includes: Enhanced Display Flexible Gooseneck Gooseneck Mounting Bracket Enhanced Display Color Options: Features: Specialty controls interface w/ 3.5 LCD display Up to 5 profiles to control drive, seat and auxiliary functions Integrated single switch scanner, Bluetooth moust emulator and IR controls Bluetooth connectivity for mobile devices Black Soft Touch Matching Non-Matching Display Color Shroud: $75 Not covered by AADL Midnight Blue USB Mobile Device Charger Not covered by AADL $185 Available with NE, NE+ and Q-Logic 2 EX controllers; Can only charge 1 device at a time. A multiplier harness is required with all Static and Tilt only seating systems. The selection of more than 3 modules requires an additional multiplier. SCIM Module Kit $730 Allows use of joystick display for specialty controls; Up to 5 profiles to control drive, seat and auxiliary functions; Excludes sip-n-puff and single switch functions; A switch is required to operate the input device attached to the SCIM module; Includes accessory bar on TB3; Only available with Q-Logic 2. Carrot Handle Joystick Handles Mushroom Handle $55 T-Bar $90 Chin Cup $55 Extended I-Handle $55 Soft Ball Handle $55 Medium Ball Handle $55 Bodypoint 3 Inch Goal Post Handle $55 Bodypoint 4 Inch Goal Post Handle $55 3 September 1, 2016

Joystick Mounting Brackets Fixed, Inline Not available with Q-Logic 2 EX Stand Alone Joystick. Left Right Swing-Away $265 Left Right Inline Offset Retract4 Swing-Away Joystick Arm Kit Full 180 Movement $345 Left Right Multi-Axis $210 Left Right No Joystick Mount TRU-Balance 3 Power Positioning Tru-Balance 3 Power Tilt 50 degree center of gravity (CG) power tilt seating system $7,555 Tru-Balance 3 Power Recline 175 degrees of power recline $7,875 Tru-Balance 3 Power Tilt & Recline $13,125 50 Degree center of gravity (CG) power tilt seating system with 175 degrees of power recline; Full drive lock-out at 20 degrees Tru-Balance 3 10 Power Adjustable Seat Lift Not covered by AADL $3,250 TRU-Balance 3 Manual Positioning Option Attendant Manual Recline $790 Available w/ Tilt only. N/A w/ NE Tilt through toggle, AFP or Back Cane Option. Push handles are required. Power Positioning Electronics Single Actuator Electronics: Through Toggle Box Tilt Only. Manual Recline back is not available through NE tilt through toggle. Left Mount Right Mount Through NE+ 6 Key Through Q-Logic 2 EX Controller $345 Through Q-Logic 2 EX Controller and Single Function with 4-Button Actuator $660 Includes AAM and 4-Button actuator module. Only available with TB3 armrests. Left Mount Dual Actuator Electronics: Through NE+ 6-Key Controller Multiple Actuator Electronics: Right Mount Through Q-Logic 2 EX Controller $345 Through Q-Logic 2 EX Controller and 4-Button Actuator Mounts to same side as controller $660 Includes AAM and 4-Button actuator module. Only available with TB3 armrests. Left Mount Right Mount Q-Logic 2 EX Through 4-way Toggle 2 $660 Left Mount Right Mount Q-Logic 2 EX Through 4-way Button Toggle 2 $660 Left Mount Right Mount 1. Bracket mounts to the outside of the armpad. 4 September 1, 2016

Seat Width: TRU-Balance 3 Seat Specifications Seat Depth: 12 W 1,3 15 W 13 W 2,3 16 W 14 W 3 17 W 2,3 18 W 19 W 20 W 21 W 22 W 23 W 24 W 12 D 4 13 D 4 14 D 15 D 16 D 17 D 18 D 19 D 20 D 21 D 22 D 23 D 24 D Seat Width Package: Seat Depth Package: 12 W-16 W 3 16 W-20 W 20 W-24 W 12 D-16 D 3 16 D-20 D 20 D-24 D 1. 16-17 depth is not available 2. Only available with non-matching back width 3. Available through SOF 4. Only available with back cane option Tilt or Tilt/Recline: 18.125 Seat to Floor 19.125 Seat to Floor 20.125 Seat to Floor Static Back TRU-Balance 3 Seat to Floor Height Recline: 17.5625 Seat to Floor 18.5625 Seat to Floor 19.5625 Seat to Floor TRU-Balance 3 Back Type TRU-Balance 3 Back Specifications Adjustable Seat Lift: 19.375 Seat to Floor 20.375 Seat to Floor 21.375 Seat to Floor Flip Forward Back Only available w/ 2-post, flip back or pediatric armrest. Not available on 12-14 widths or with attendant manual recline. $25 Back Cane Option Only available with Omit Back and 2-post, flip back or pediatric armrests. Not available with recline. -$735 Back Cane Type: Angle Adjustable Flip Forward 1 Endo 2 Endo Back Cane Height: 16 H 17 H 20 H 21 H 24 H 25 H +/-4 of Seat Width. Odd heights = 4 Gap, even heights = 3 gap. Measurements listed is overall back height. Sport Back 12 Wx14 H 12 Wx15 H 14 Wx16 H 14 Wx17 H 16 Wx16 H 16 Wx17 H 16 Wx18 H 16 Wx19 H 16 Wx20 H 16 Wx21 H 16 Wx22 H 16 Wx23 H 17 Wx16 H 17 Wx17 H 17 Wx18 H 17 Wx19 H 17 Wx20 H 17 Wx21 H 17 Wx22 H 17 Wx23 H 18 Wx16 H 18 Wx17 H 18 Wx18 H 18 Wx19 H 18 Wx20 H 18 Wx21 H 18 Wx22 H 18 Wx23 H 18 Wx24 H 18 Wx25 H 19 Wx16 H 19 Wx17 H 19 Wx18 H 19 Wx19 H 19 Wx20 H 19 Wx21 H 19 Wx22 H 19 Wx23 H 20 Wx16 H 20 Wx17 H 20 Wx18 H 20 Wx19 H 20 Wx20 H 20 Wx21 H 20 Wx22 H 20 Wx23 H 20 Wx24 H 20 Wx25 H 21 Wx16 H 1 21 Wx17 H 1 21 Wx18 H 1 21 Wx19 H 1 21 Wx20 H 1 21 Wx21 H 1 21 Wx22 H 1 21 Wx23 H 1 21 Wx24 H 1 21 Wx25 H 1 22 Wx16 H 22 Wx17 H 22 Wx18 H 22 Wx19 H 22 Wx20 H 22 Wx21 H 22 Wx22 H 22 Wx23 H 23 Wx16 H 1 23 Wx17 H 1 23 Wx18 H 1 23 Wx19 H 1 23 Wx20 H 1 23 Wx21 H 1 23 Wx22 H 1 23 Wx23 H 1 24 Wx16 H 24 Wx17 H 24 Wx18 H 24 Wx19 H 24 Wx20 H 24 Wx21 H 24 Wx22 H 24 Wx23 H Back Width Package: 10 W-14 W 16 W-20 W 20 W-24 W 1. Not available with TRU-Comfort Back 5 September 1, 2016

Back Color Shroud Option: Back in Black Back Color Option $105: Not covered by AADL Midnight Blue TRU-Balance 3 Back Specifications Large Lateral Positioning Wedge, pair Additional TRU-Balance 3 Back Options Not available on Tilt Backs 16-17 H w/ limited adjustability on 18 H. Not available on Recline Backs 19-20 H w/ limited adjustability on 21 H. N/A with Back Cane Option Aftermarket Back Interface Overall seat depth may need to be adjusted to accommodate certain backs. May interfere with gel/waterfall armpads and arm through. Contact your Quantum specialist for details. Does not include brackets to mount aftermarket back. SOF is required on back widths less than 16. Omit Back Privacy Flap: on recline seating systems. Not covered by AADL 9.75 W $40 12.75 W $40 Lap Belts 38 Lap Belt 50 Lap Belt 60 Lap Belt 70 Lap Belt 80 Lap Belt 90 Lap Belt 6 September 1, 2016

Armrests TB3 Armrests May interfere with swing-away laterals. Choose height package below. Down Post +/- up to 2 difference between seat and back width. Not Available on 14 W Seat/Back $95 ( on Systems with Recline) Left Armrest Height Package: Right Armrest Height Package: 8-12 Height 12-16 Height 8-12 Height 12-16 Height 2-Post, Flip Back, Height Adjustable, Removable Height range 9-13 Not available with a depth less than 16 ; Required with flip forward back and laptrays. Pediatric, Removable, Height Adjustable Height adjustment from 7.75 to 9.75 in 1/2 increments. Not available with full length armpads. Left Armpad Length: Left Armpad Style: Falcon, Gel, Full Length 3 W x 14 L Mounting Plate, Full Length 1 Falcon, Gel, Desk Length 3 W x 10 L Mounting Plate, Desk Length 1 $85 ea. $60 ea. $67.50 ea. $60 ea. Right Armpad Length: 14 L Full Length 10 L Desk Length 14 L Full Length 10 L Desk Length Right Armpad Style: Straight Waterfall Straight Waterfall Falcon, Gel, Full Length 3 W x 14 L Mounting Plate, Full Length 1 Falcon, Gel, Desk Length 3 W x 10 L Mounting Plate, Desk Length 1 1. Required only with 2-post, flip back, height adjustable, removable armrests or pediatric armrests. Interference with Back may occur. $85 ea. $60 ea. $67.50 ea. $60 ea. TRU-Balance 3 Complimentary Accessories Not covered by AADL Choose one complimentary item in this section. Each additional item will be billed with the MSRP listed below. Cup Holder Not available with 2-post, flip back or pediatric armrests or Back Cane Option $35 Personal Item Hook Not available with Back Cane Option $35 Reflector Kit $35 Cell Phone/Media Holder Not available w/ 2-post, flip back or pediatric armrests or Back Cane Options $95 Backpack Holder, pair Not available with Back Cane Option. $42 TRU-Balance 3 Premium Installed Accessories Not covered by AADL Trilogy Vent Tray $420 Not available with Back Cane option Compact Vent Tray $1,465 Push Handles (pair) $140 Not available with O2 holder, Back Cane Option, or vent tray. Required with attendant manual recline. Accessory bar $90 Comes standard with the SCIM module, Trilogy vent tray and O2 holder. May be added to mount additional accessories to back of unit. Additional Accessories Not covered by AADL Quantum Backpack $65 May interfere with other rear accessories Weather Cover, Large, Black $168 7 September 1, 2016

TRU-Balance 3 Premium Accessories Not covered by AADL Premium accessories will be shipped with the unit, not installed. Multiple accessories can be mounted along the various tracks, some interference may occur. Clothing Guard, Pair $275 Glove Box $40 Oxygen Holder $90 Oxygen Holder for use w/ Back Cane Option $90 Transfer Bar, Pair (Quick Release) $305 Transfer Bar, Pair (Bolt-On) $305 ipad Holder $565 Headrests Headrest Pads Stealth 10 Comfort Plus $190 Stealth 14 Comfort Plus $190 Stealth Small Contoured (9.75 W x 3 H) $80 Stealth Large Contoured (11 W x 6 H) $100 Headrest Mounts Stealth Removable Headrest Bracket $200 Stealth s Worlds Best Removable Headrest Bracket $255 No Bracket 8 September 1, 2016

Center Mount Foot Platforms All efforts will be made to accommodate legrest length selection, but minor changes may be needed to be made to meet shipping guidelines. Some adjustment may be needed upon receipt of unit. Adjustable Center Mount Foot Platform 12 W 20 W $265 Adjustable Center Mount Foot Platform 20 W 24 W $475 Center Mount Power Articulating Foot Platform Includes 10 W x 11 D Split Footplates Not covered by AADL $3,145 Extensions: 10-16 L Footplates: 13-19 L 10 W x 11 D Split Footplates 10 W x 8 D Split Footplates 10 W x 6 W Split Footplates Calf Supports: Calf Pads (pair) Small 1 (6 H x 6 W) $210 Large 1 (8 H x 8 W, tapered to 6 W) $210 Calf Pad Covers (pair) (1/2 Soft Visco Foam) Air Mesh $150 Reversed Dartex $150 Calf Panel (ea.) Small (8 H x 18 W) $210 Large (8 H x 24 W) $265 Only available on 20 W or greater. Calf Panel Covers (1/2 Soft Visco Foam) Air Mesh $150 Reversed Dartex $150 1. Comes standard with articulation foot platform Optional Modular Footplate Extension Components/Kits: Clinical Justification Required Assembly required. May require seating configuration adjustments to avoid front caster interference. Not available with 10"W x 8"D Split Footplates. Extension Kits... $55 Side Guards... $55 4 Width 2 Bel Shaped, Length Extension 4 Side Guard 1 6 Side Guard 2 1. Available with 6 D Footplates 2. Available with 8 and 11 D Footplates Wheel Bumpers (pair) $30 Footplate Connector $55 9 September 1, 2016

Powered Elevating Legrests All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. 70 Power Articulating Swing-Away Legrests 4 articulation range Not covered by AADL $2,865 Use code K0108 for an individual legrest. Rigging Selection: Matching Legrests (pair) Non-Matching Legrests (pair) Individual Legrests Left or Right Only Operation Method: Independent Combined Footplate Selection: Angle Adjustable Footplates (pair) Includes heel loops. Left Legrest Lower Extensions: Angle Adjustable Footplate Size: Right Legrest Lower Extensions: 11-13 L 14.5-18 L 11-13 L 14.5-18 L 4 W x 6 D 5 W x 6 D 5 W x 8 D 6 W x 11 D 1 4 W x 6 D 6 W x 8 D 1 8 W x 11 D 2 5 W x 6 D 5 W x 8 D 6 W x 11 D 1 6 W x 8 D 1 8 W x 11 D 2 Accessories: Calf Pad (pair) Gel Padded Knee Adductor Buttons (pair) $130 1. May cause interference on seat widths less than 18 2. May cause interference on seat widths less than 20 Non-Powered Legrests All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. 60-90 Swing-Away Legrests adjustable in 5 Increments Foam Cover Rigging Selection: Matching Legrests (pair) Non-Matching Legrests (pair) Individual Legrests Left or Right Only Footplate Selection: Angle-Adjustable Footplates (pair) Includes Heel Loops. $175 Multi-Axis Footplates (pair) Includes Heel Loops. $520, Extruded Footplates (pair) Lower Extensions: 11-13 L 1 Left Legrest: Angle Adjustable/Multi-Axis Footplate Size: 4 W x 6 D 5 W x 8 D 5 W x 6 D, Extruded Footplate Size: 1. Not available with multi-axis footplates. 2. Not available w/ Angle Adjustable Footplates Lower Extensions: Right Legrest: 13-16.5 L 1 11-13 L 1 13-16.5 L 1 11-16.5 L 2 15.5-19.5 L 1 11-16.5 L 2 6 W x 11 D 3 4 W x 6 D 6 W x 8 D 3 8 W x 11 D 4 5 W x 6 D 15.5-19.5 L 1 7.25 W x 6 D 8.5 W x 6 D 3 7.25 W x 6 D 8.5 W x 6 D 3 3. May cause interference on seat widths less than 18 4. May cause interference on seat widths less than 20 5 W x 8 D 6 W x 11 D 3 6 W x 8 D 3 8 W x 11 D 4 Accessories: Heel Loops (pair) on Angle Adjustable and Multi-Axis footplates $35 Wheel Bumpers (pair) $30 Gel Neoprene Footrest Sleeve (pair) $130 10 September 1, 2016

Non-Powered Legrests (cont.) All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. 90 Pediatric Swing-Away Legrests Rigging Selection: Matching Legrests (pair) Non-Matching Legrests (pair) Individual Legrests Left or Right Only Footplate Selection: Angle-Adjustable Footplates (pair) Includes heel loops. $175 Left Legrest: Lower Extensions: 7-10 L Angle Adjustable Footplate Size: 4 W x 6 D 5 W x 6 D Lower Extensions: 7-10 L Right Legrest: 4 W x 6 D 5 W x 6 D Accessories: Wheel Bumpers (pair) $30 Elevating Legrests $550 Rigging Selection: Matching Legrests (pair) Non-Matching Legrests (pair) Individual Legrests Left or Right Only Footplate Selection: Angle-Adjustable Footplates (pair) Includes Heel Loops. $175, Extruded Footplates (pair) Left Legrest Lower Extensions: Right Legrest Lower Extensions: 11-14 L 1 14-17 L 1 11-14 L 1 14-17 L 1 12-14.5 L 2 14.5-18 L 2 12-14.5 L 2 14.5-18 L 2 Angle Adjustable Footplate Size: Left Legrest: Right Legrest: 4 W x 6 D 5 W x 8 D 5 W x 6 D, Extruded Footplate Size: Left Legrest: Left Legrest: 7.25 W x 6 D 8.5 W x 6 D 3 7.25 W x 6 D 8.5 W x 6 D 3 Accessories: Heel Loops (pair) on Angle Adjustable and Multi-Axis footplates $35 Wheel Bumpers (pair) $30 Gel Padded Adductor Buttons (pair) $130 1. Not available with angle adjustable footplates. 2. Not available with standard, extruded footplates. 6 W x 11 D 3 4 W x 6 D 6 W x 8 D 3 8 W x 11 D 4 5 W x 6 D 3. May cause interference on seat widths less than 18. 4. May cause interference on seat widths less than 20. 5 W x 8 D 6 W x 11 D 3 6 W x 8 D 3 8 W x 11 D 4 11 September 1, 2016