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
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1 Australian Importer: Paragon Mobility Phone Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Focus CR E1161 Add Charge 300 lb weight capacity. Tilt range: -5º anterior to 50º posterior. Frame Width Frame Width Range / Frame Width Select Frame Width within desired Frame Width Range Frame Width Frame Width Range Small Medium Large Seating Setup OPTION 2: Setup By Frame Depth Select Frame Depth within desired Frame Depth Range Frame Depth Range Short q 14 q 15 q 16 q 17 q 18 q 16 q 17 q 18 q 19 q 20 q 18 q 19 q 20 q 21 q 22 Make one selection from either Option 1 at right or Option 2 below based on desired seating setup Frame Depth q 14 q 15 q 16 q 17 q 18 Effective 07/04/2016 Ship To: Address: City: State: Zip: Phone: /Fax: HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer s coverage policy. OPTION 1: Setup By Ki Mobility Select Seat Depth corresponding to desired Frame Depth Range row and Backrest Offset cloumn. Note: All Seat Depths in a column and within the same frame depth range are achievable with future adjustment. Backrest Offset A Frame Depth -2-1 Flush Range Seat Depth 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 q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14 Medium q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 15 q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 15 Long q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 22 2 q 21 1 q 20 1 q 19 q 18 1 Add Charge 2 Add Charge A Medium q 16 q 17 q 18 q 19 q 20 Back Canes 2 Rearward Flush Long q 18 q 19 q 20 q 21 q 22 2 Forward 4 Forward Front of Chair DCN Pricing and specifications subject to change without notice Page 1 of 9
2 Frame Options Heavy Duty Option q 400 lb Weight Capacity Add Charge Available only on chairs 18 x 18 or larger and requires 8 x 2 Casters Transit Option q Transit System K0108 Add Charge Vent and Battery Tray Not available on 14 or 15 Frame Widths or with Foot Tilt Mechanism, Attendant Foot Lock or 5 casters. Requires minimum 16 Seat Height. q Vent Tray E1029 Add Charge Requires Anti-Tip q Battery Box Holder E1029 Add Charge Offset Hanger Option q Offset Hanger Add Charge Tilt Stop included. No anterior tilt. Tilt Mechanism Hand q Hand Tilt - Right N/C q Hand Tilt - Left N/C Foot q Foot Tilt - Right N/C q Foot Tilt - Left N/C New! Power Tilt Not available with Vent Tray, Battery Box Holder or Heavy Duty Option q Power Tilt - Right Add Charge q Power Tilt - Left Add Charge Backrest Back Post / Height Range / Back Height Select Back Height in row corresponding to desired Back Post and Height Range Back Post Price Height Range Back Height Stroller Handle Short q 20 Back Post N/C (Folding) Tall q 24 Adjustable Height with Adjustable Handle (Folding) Reclining Back with Adjustable Handle 1, 2 (Non-folding) N/C Add Charge Short 1, 2 q 18 q 19 q 20 q 21 q 22 q 23 q 24 q 25 Tall q 20 2 q 21 2 q 22 2 q 23 q 24 q 25 q 26 q 27 Short q 22 Tall q 26 1 Not available with O2 Holder 2 Not available with Seating Dynamics Rocker Back Stroller Handle Back Post Option Available only with Stroller Handle Back Post q Removable Stroller Handle Extension Add Charge Reclining Backrest Options Select options below if Reclining Back is selected on chart above Recline Angle: q 0º - 65º E1225 q 10º - 75º E1225 q 20º - 85º E1226 Other Backrest Options q Non Folding Back N/C Standard with Reclining Back and Seating Dynamics Rocker Back q Seating Dynamics Rocker Back K0108 Add Charge Not available with Angle Adjustable Locking Extendable Flip Up Armrests. Available only with Non Folding Back. Not available with Reclining Backrest. q Adjustable Height Rigidizer Bar New! Add Charge Gas Spring: q Standard Spring q Heavy Duty Spring DCN Pricing and specifications subject to change without notice Page 2 of 9
3 Footrest Hanger / Front Frame Bend q 60º N/C Available only with Extension Tube Hangers q 70º N/C q 80º N/C Not available with 7 or 8 Casters q 90º N/C Available only with Front Mount Hangers. Not available with 7 or 8 Casters. q Elevating Leg Rests (ELR) E0990 Add Charge q Omit Hangers N/C Footplate Heel Loops not included q Composite N/C Not available with Front Mount Hangers q Aluminum Angle Adjustable K0040 Add Charge q One Piece Flip Up Angle Adjustable K0040 Add Charge Not available with Front Mount Hangers or Elevating Leg Rests Footrest / Extension / Seat to Footrest Length Select Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5 shorter than Front Seat Height recommended. Extension Tube Hanger measurements based on 70º Hanger Bend. Footrest Extension Seat to Footrest Length Extension Tube Hangers (60º, 70º, 80º) Short q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 Medium q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 Long q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 Front Mount Hangers 1 Short (70º, 80º, 90º) Medium (70º, 80º, 90º) Long (70º, 80º) Standard Selections Requires 3 Extension q 5 q 5.5 q 6 q 6.5 q 8.5 q 9 q 9.5 q 7 q 7.5 q 8 q 10 q 10.5 q 11 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 10.5 q 11 q 11.5 q 8 q 8.5 q 9 q 9.5 q 10 q 12 q 12.5 q 13 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 12.5 q 13 q 13.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 14 q 14.5 q 15 Elevating Leg Rests (ELR) Short q 10.5 q 11.5 q 12.5 q 13.5 q 14.5 Long q 12.5 q 13.5 q 14.5 q 15.5 q 16.5 Extended Length ELR Short q 15.5 q 16.5 q 17.5 q 18.5 q 19.5 Long q 17.5 q 18.5 q 19.5 q 20.5 q Available only with Aluminum Angle Adjustable Footplates. See Minimum Front Seat Height chart below. Minimum Front Seat Height with Front Mount Hangers Hanger Length Short Medium Long Hanger Bend 70º 80/90º 70º 80/90º 70º 80º Minimum Front Seat Height with Standard Selection Minimum Front Seat Height with 3 Extension Heel Loop q Heel Loops E0951 Add Charge Not available with One Piece Flip Up Angle Adjustable Footplate q Omit Heel Loops N/C Calf Strap q Velcro Adjustable K0038 Add Charge q Padded Velcro Adjustable K0038 Add Charge q Bodypoint Padded AeroMesh K0038 Add Charge 3 Extension Available only with Front Mount Hangers. Provided as parts. q 3 Extension for Front Mount Hanger N/C Residual Limb Support q Residual Limb Support E1020 q Left Add Charge q Right Add Charge q Omit Left Hanger N/C q Omit Right Hanger N/C Cover q Smooth q Air Mesh q Smooth q Air Mesh Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14 DCN Pricing and specifications subject to change without notice Page 3 of 9
4 Seat Height, Casters and Rear Wheels Seat Height / Caster Size / Rear Wheel Size Select Seat Height corresponding to desired Rear Wheel and Caster Size Rear Wheel Size 12 5 with Pneumatic or Pneumatic with Airless Insert Tire 12 5 with Full Profile Poly Tire with Drum Brake Caster Size HD x x 2 8 x 2 Seat Height q 13.5 q 14 q 14.5 q 14.5 q 14.5 q 17 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19 q 19 q 19 q 19 q 19 q 19 q 19 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 16.5 q 16.5 q 16.5 q 17 q 17 q 17 q 17 q 17 q 17 q 17 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19 q 19 q 19 q 19 q 13 q 13.5 q 14 q 14 q 14 q 14.5 q 14.5 q 14.5 q 15 q 15 q 15 q 15 q 15.5 q 15.5 q 15.5 q 15.5 q 16 q 16 q 16 q 16 q 16 q 16 q 16 q q 16.5 q q q q q 19 q 19 q 19 q 19 2 q 19 q 19 q 19 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 20 q 20 q 20 q 20 q 20 q 20 q 20 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 13.5 q 14 q 14 q 14 q 14.5 q 14.5 q 14.5 q 15 q 15 q 15 q 15 q 15.5 q 15.5 q 15.5 q 15.5 q 16 q 16 q 16 q 16 q 16 q 19 q 19 q 19 q 19 q 19 q 19 q 19 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 20 q 20 q 20 q 20 q 20 q 20 q 20 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q Available only with poly tire 2 Not available with poly tire 3 Available only with spoke wheel and poly tire combination 4 Not available with spoke wheel and poly tire combination 5 Not available with Vent and Battery Tray combination 6 Seat heights higher than 16.5 with 16 Rear Wheel Size are not available with Vent and Battery Tray combination Rear Wheel Size Caster Size HD x x 2 8 x 2 Seat Height q 15 q 15 q 15 q 15 q 15.5 q 15.5 q 15.5 q 15.5 q 16 q 16 q 16 q 16 q 16 q 16 q 16 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 17 q 17 q 17 q 17 q 17 q 17 q 17 q 18.5 q 18.5 q 18.5 q 18.5 q 16 q 16 q 16 q 16 q 16 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 17 q 17 q 17 q 17 q 17 q 17 q 17 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19 q 19 q 19 q 19 q 19 q 19 q 19 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q q q q q 17 q 17 q 17 q 17 q 17 q 17 q 17 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 19 q 19 q 19 q 19 q 19 q 19 q 19 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 20 q 20 4 q 20 q 20 q 20 q 20 2 q 20 2 DCN Pricing and specifications subject to change without notice Page 4 of 9
5 Seat Height, Casters and Rear Wheels continued Caster Type q 1 Poly N/C q 1 Poly Aluminum Add Charge Available only with 5 Caster Sizes q 1 Pneumatic Add Charge Available only with 6 and 8 Caster Sizes q 1.5 Poly Add Charge Available only with 5 and 6 Caster Sizes q 1.5 Soft Roll Aluminum Add Charge Available only with 5 and 6 Caster Sizes q 2 Poly Add Charge Available only with 6 Caster Size q 2 Pneumatic w/ Foam Insert Add Charge Available only with 8 Caster Size Rear Wheel Type q Mag N/C q 24 Spoke Add Charge Axle q Fixed N/C q Quick Release N/C q Self Propel Axle Plate New! Add Charge Not available with Vent Tray, 12 or 16 Rear Wheel Size New! One Arm Drive q One Arm Drive Add Charge Available only with 24 Mag wheels. Not available with Vent Tray, Battery Box Holder or Self Propel Axle Plate. Standard Handrim will be Aluminum Anodized. Drive Handrim Side: q Left q Right Drive Handrim Type: q Aluminum N/C q Poly Coated Add Charge Wheel Locks Wheel Lock Select ONE option below q Push to Lock N/C Add Charge when ordered with Drum Brake q Pull to Lock N/C Add Charge when ordered with Drum Brake q Attendant Foot Lock Add Charge Not available with Drum Brake q Drum Brake E2228 Add Charge Not available with Hand Tilt Mechanism, Reclining Backrest or Attendant Foot Lock q Omit Wheel Locks N/C Armrests Rear Tire Type q Full Profile Poly N/C q Pneumatic N/C q Pneumatic with Airless Insert E2211, E2213 Add Charge Handrim Handrims not available on 12 or 16 Rear Wheel Sizes. No selection needed with One Arm Drive Standard Handrims q Aluminum Anodized Std q Plastic Coated Add Charge q Projection (8 Vertical Projections) Add Charge Available on 24 Rear Wheel Size q Omit Handrims N/C New! Natural Fit Handrims Not available on 20 Rear Wheel Size or 22 Mag wheels q Natural Fit LT Regular Grip Add Charge q Natural Fit Standard Regular Grip Add Charge q Natural Fit LT Super Grip Add Charge q Natural Fit Standard Super Grip Add Charge q Natural Fit LT Omit Grip Add Charge q Natural Fit Standard Omit Grip Add Charge Handrim Option Available only on Aluminum Anodized Handrims q 3M Micro Grip Add Charge Wheel Lock Options q Extension Handles E0961 Add Charge Not available on Attendant Foot Lock or Drum Brake Armrest Please select Arm Pad option q Height Adjustable T-Arm (8-13 ) E0973 Add Charge Not available with Heavy Duty option q Height Adjustable T-Arm Low ( ) New! Add Charge Not available with Heavy Duty option q Height Adj. Dual Post Flip Back ( ) E0973 Add Charge q Angle Adjustable Locking Extendable Flip Up Add Charge Not available with Seating Dynamics Rocker Back or Heavy Duty option. Minimum armrest height with Reclining Backrest is 12. q Omit Armrests N/C Arm Pad Standard Arm Pad N/C q Desk q Full Waterfall Arm Pad Add Charge q Desk q Full Not available with Angle Adjustable Locking Extendable Flip Up Armrests Foam Grip New! N/C q Desk q Full Available only with Angle Adjustable Locking Extendable Flip Up Armrest DCN Pricing and specifications subject to change without notice Page 5 of 9
6 Accessories Removable Side Guard q Composite Side Guards K0108 Add Charge Not available with T-Arm or Dual Post Flip Back Armrests Anti-Tip q Rear Anti-Tips E0971 Add Charge Required with Reclining Backrest and Vent Tray Positioning Belt q 1 1/2 Auto Buckle E0978 Add Charge q 1 1/2 Padded Auto Buckle E0978 Add Charge q 2 Airline Buckle E0978 Add Charge q Bodypoint Evoflex - Pelvic Stabilizer E0978 Add Charge Size: q Small (16-24 ) q Medium (19-29 ) q Large (25-37 ) Belt Mounting Kit q Ki Mobility Belt Mounting Brackets Add Charge q Bodypoint 1 Band Clamp Belt Mounting Kit Add Charge Seat Pan q Growing Adjustable Aluminum Seat Pan E2231 Add Charge O 2 Holder q O 2 Holder E2208 Add Charge Not available with Transit Option, Reclining Backrest or Rocker Back Other Accessories q Tool Kit Add Charge q Removable Underseat Pouch Add Charge q Ki Mobility Backpack Add Charge q Black Neoprene Impact Guards Add Charge q Clear Spoke Guards K0065 Add Charge Available only with Spoke wheels q Black Spoke Guards K0065 Add Charge Available only with Spoke wheels q Tilt Stop (Pair) K0108 Add Charge Included with Offset Hangers q IV Pole Add Charge Frame Color Gloss Finish q Black N/C q Blue Skies N/C q Bright Orange N/C q Bubblegum Pink N/C q Candy Blue N/C q Candy Purple N/C q Candy Red N/C q Copper N/C q Fuchsia N/C q Granny Smith N/C Matte Finish q Army Green N/C q Emerald Green N/C q Iridescent Burgundy N/C q Iridescent Navy N/C q Retro Red N/C q Royal Blue N/C q Shadow Black N/C q Charcoal Gray New! N/C q Smooth White N/C DCN Pricing and specifications subject to change without notice Page 6 of 9
7 Cushions Comfort Company Seat Cushions STEP 1: Choose Cushion q Comfort Company Curve Cushion (14 x14 to 20 x20 ) Add Charge q Comfort Company Curve Cushion (Over 20 x20 ) Add Charge STEP 2: Choose Cushion Size q Match to Chair Size q Other Size - Provide Part Number RIDE DESIGNS Seat Cushions Cushion size is determined by chair dimensions. Certain sizes will have higher price and longer lead time; visit for size specifications. STEP 1: Choose Cushion q Forward Cushion Add Charge Cushions have a weight capacity of 250 lbs. q Java Cushion Add Charge Weight capacity of 300 lbs q Additional Cushion Cover Add Charge STEP 2: Choose Cushion Size q Match to Chair Size q Other Size - Provide Part Number Backs Ride Designs Backs q Java Back Regular Add Charge Back Width: q 14 q 15 q 16 q 17 q 18 q 19 q 20 q Java Back Tall Add Charge Therafin Headrest for MATRX Back Systems q Headrest, Multi-Axis Offset Hardware with Smooth/Soft Pad (E1028, E0955) Add Charge PAD SIZE: q 5 x 8 q 5 x 10 q 5 x 14 Ride Designs Headrest Mounting Hardware Plate Back Width: q 14 q 15 q 16 q 17 q 18 q 19 q 20 q Java Back Grande Add Charge Back Width: q 14 q 15 q 16 q 17 q 18 q 19 q 20 q Add Charge For mounting most manufacturers Headrest hardware. q Backrest Depth: Standard 3 Contour q Backrest Depth: Deep 6 Contour DCN Pricing and specifications subject to change without notice Page 7 of 9
8 Vest q Full Shape, Comfort Strap (E0960) Add Charge q Small q Medium q Large q X-Large q 2X-Large q Full Shape, Extended Strap (E0960) Add Charge q Small q Medium q Large q X-Large q 2X-Large q Trim Shape, Comfort Strap (E0960) Add Charge q Small q Medium q Large q X-Large q 2X-Large q Trim Shape, Extended Strap (E0960) Add Charge q Small q Medium q Large q X-Large q 2X-Large Shoulder Harness With metal clips and cam locks q Small (E0960) Add Charge q Medium (E0960) Add Charge q Large (E0960) Add Charge q X-Large (E0960) Add Charge Hip Belt q 4 Point Y-Style, Metal Buckle (E0978) Add Charge q Small q Medium q Large q Dual Rear Pull, Metal Attaching Clips (E0978) q 1 Straps, 6.25 W x 1.75 H Pads Add Charge q 1.5 Straps, 7.25 W x 2.25 H Pads _Add Charge q 1.5 Straps, 9.25 W x 2.5 H Pads Add Charge q Single Pull, Metal Buckle (E0978) q 1 Straps, 4.25 W x 1.75 H Pads Add Charge q 1 Straps, 5.25 W x 1.75 H Pads Add Charge q 1 Straps, 6.25 W x 1.75 H Pads Add Charge q 1.5 Straps, 5.25 W x 2.25 H Pads _Add Charge q 1.5 Straps, 9.25 W x 2.5 H Pads Add Charge q 2 Straps, 9.25 W x 3 H Pads Add Charge q 2 Straps, W x 3 H Pads Add Charge Knee Adductor q Flip Down Hardware (E1028) Add Charge Sold in pairs, one right side and one left side q Short Arm, Fits 3/4, 7/8 and 1 Tubing q Long Arm, Fits 3/4, 7/8 and 1 Tubing q Knee Adductor Pad with Neoprene Cover (E0956) Add Charge Sold single q Small Pad, 4.25 x Quantity: q Medium Pad, 6.25 x Quantity: Foot / Shoe Holder Compatible only with Angle Adjustable Footplates q FootSure Ankle Support (K0108) Add Charge Sold in pairs q X-Small w/ Buckle Closure, 6-8 Circum q Small w/ Buckle Closure, Circum q Medium w/ Buckle Closure, 8-11 Circum q Large w/ Buckle Closure, 9-12 Circum q X-Large w/ Buckle Closure, Circum q X-Small w/ Hook-N-Loop Closure, 5-6 Circum q Small w/ Hook-N-Loop Closure, 6-8 Circum q Med w/ Hook-N-Loop Closure, Circum q Large w/ Hook-N-Loop Closure, 9-12 Circum q X-Lrg w/ Hook-N-Loop Closure, Circum q Padded Footbox (K0108) q Small, Full Design, Fits 14 Chair Add Charge q Medium, Full Design, Fits 16 Chair Add Charge q Small, Split Design, Fits 14 Chair Add Charge q Medium, Split Design, Fits 16 Chair _Add Charge q Large, Split Design, Fits 18 Chair Add Charge q Molded Shoe Holders (K0108) Add Charge Sold in pairs q Small with Plain Straps, 3.5 x q Medium with Plain Straps, 4 x q Large with Plain Straps, 4.75 x q X-Large with Plain Straps, 5 x Cane Mounted Swing Away Lateral Thoracic Support Sold as pair q Swing Away Kits w/ 4 x6 Gel Pads Add Charge q Swing Away Kits, No Pads (E0956, E1028) Add Charge DCN Pricing and specifications subject to change without notice Page 8 of 9
9 Half Tray q Standard Shape, Clear, Flip-Away (E0950, E1028) Add Charge q Right Side q Left Side q Standard Shape, Padded, Flip-Away (E0950, E1028) _ Add Charge q Right Side q Left Side q Trimline Shape, Padded, Flip-Away (E0950, E1028) Add Charge q Right Side q Left Side Clear Tray with Border and Pre-Drilled Holes STEP 1: Choose Tray Chair Width Tray Dimension ( W x D ) Body Cutout ( W x D ) Part Number Price 20 x x Add Charge q 20 x x Add Charge q 21 x x Add Charge q 21 x x Add Charge q 22 x x Add Charge q 22 x x Add Charge q 23.5 x x Add Charge q 23.5 x x Add Charge q 24.5 x x Add Charge q 24.5 x x Add Charge q 26.5 x x Add Charge q 26.5 x x Add Charge q 26.5 x x Add Charge q 26.5 x x Add Charge q 27.5 x x Add Charge q 27.5 x x Add Charge q 28.5 x x Add Charge q 28.5 x x Add Charge q Communication Mount Hardware Choose Device Holder AND Mount STEP 1: What DEVICE will be used? q Smart Phone Add Charge q Large Smart Phone Add Charge q I-Pad Add Charge q I-Pad Mini Add Charge q 7 Tablet Add Charge q 10 Tablet Add Charge STEP 2: Where does it need to MOUNT? q Frame Add Charge q Armrest Add Charge q Tray Add Charge Cup Holder q Heavy Duty Add Charge Compatible only with Height Adjustable Dual Post Flip Back Armrests STEP 2: Choose Tray Hardware q E-Z Lock Clamps, Standard (E1028) Add Charge Sold in Pairs DCN Pricing and specifications subject to change without notice Page 9 of 9
Prescription Total. 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
Effective 15/05/2018 Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Focus CR 2309 300 lb weight capacity. Tilt range: -5º anterior to 50º posterior. Frame Width Address: 19C Ballinderry
More informationq Icon TM Backs (Low, Mid, Tall, Deep ) $ q Evolution TM Backs (Regular, Tall, Deep ) $
Distributed in Canada by 49 Bespoke, Inc. 51 Caldari Road, Units 6-7B Concord, ON L4K 4G3 Phone: (866) 827-4548 Fax: (877) 731-7745 sales@kimobility.ca www.kimobilty.ca Company: Account Number: Date: q
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Frame Depth. Range. Short. Medium.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Frame Depth. Range. Short. Medium.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
More informationq Standard Seat Sling Std q Omit Seat N/C
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number:
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This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Effective 05/14/2018 Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: q Catalyst
More informationq Solid Seat Pan $265
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada Company: Account Number: Date: q Quote q PO Number: RTS: Ship To: Address: City: State:
More informationq Solid Seat Pan E2231 $265
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Ship To: Address: City: State: Zip: Phone:
More informationq Solid Seat Pan E2231 $265
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Ship To: Address: City: State: Zip: Phone:
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Cross Brace
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Cross Brace $250 WAMA $250 WAMA
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number:
More informationTransit Option. Seat Option E2201 E2201. Cross Brace
Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Catalyst 5Vx K0005 $1895 300 lb weight capacity Ship To: Address: City: State: Zip: Phone: Email/Fax: Effective 08/06/2018 Frame Seat
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Transit Option. Seat Option.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Catalyst 5Vx K0005 $1895
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Transit Option.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Transit Option E2201 E2201.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
More informationq Growing Seat Sling N/C q Growing Solid Seat Pan E2231 $245 q Omit Seat N/C q 1 N/C
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Little Wave - Clik XPe K0005,
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Rogue XPe K0005, E1235 $2415
More informationThis form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Canada Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Rogue XP $3705 Rogue
More informationq PG Controller $700 E2377 q Harness for Expandable Controller $350 E2313 q Remote Plus 3-Key $700 q1 Profile q Multiple Profile
Jazzy 1113ATS Discount: Terms: Freight: Taken By: Order Form 300lb Wt Cap Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA 18643 Phone: (866)800-2002 Fax: (866) 707-3422 Account Number:
More informationHigh Back BH from seat: 29.5 Seat Height from floor: 16-20
Marcella 500lb. Chair No charge on all Felix Chairs for Custom Embroidered Logos Shown with neck roll cushion and lumbar pillow. Standard at no upcharge on high back chair Shown with lumbar pillow standard
More informationCLICK FOR SURFACES, TEXTILES, GRADED-IN TEXTILE DATA BASE PRODUCT SPECIFICATIONS
k a r d i a t r a n s p o r t c h a i r s PRODUCT SPECIFICATIONS THIS COMPLETE COLLECTION OF SEATING IS THOUGHTFULLY DESIGNED FOR SEAMLESS SPECIFICATION THROUGHOUT HIGH TRAFFIC HEALTHCARE FACILITIES. INTELLIGENT
More informationVisit any one of our 30 locations or visit us on line at
TYPE IA ALUMINUM 2886509079 2886501870 2886510013 2886510010 2886510014 2886504441 AS3002 2' TYPE IA AS3003 3' TYPE IA AS3004 4' TYPE IA AS3006 6' TYPE IA AS3008 8' TYPE IA AS3010 10' TYPE IA 34.99 57.99
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Distributed by: alber Power Mobility Products Suggested Canadian Price List Effective March 2nd, 2009 Revised April 18th, 2012 *UPDATED - DENOTES CHANGES Model Number Description Sugg. List Price e.motion
More information6.0 PRICE SCHEDULE - ONE WAY SNOW PLOW
Price quote for: 6.0 PRICE SCHEDULE - ONE WAY SNOW PLOW Vendor Name: Contact Person: Street Address: P.O. Box: City, State, Zip: Phone #: Toll Free #: Fax #: Email Address: Bert's Truck Equipment of Moorhead,
More informationVariable Speed 20" Single and Multi-spindle, Belt Drive Industrial Drill Presses
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