4 Page. Pediatric Cushions. Standard Cushions. Bariatric Cushions. Modifications & Accessories
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- Myles Edgar Perry
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1 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM Effective November 1st, 2014 Date of Order: Ship to Address: Dealer Name: Dealer Accout #: City: PO #: State: Zip: Tag: Commets: Purchasig Cotact: Phoe: Fax: Pediatric Cushios 4 Page Ivacare Matrx Kid*ab*ra Cushio/Extra 2 Ivacare Matrx Kid*ab*ra Kid*ab*ra Drop Base/Extra 2 Ivacare Matrx PS Cushio/Extra 6 Stadard Cushios 4 Page Ivacare Matrx Vi Cushio/Extra 3 Ivacare Matrx Vi Drop Base/Extra 4 Ivacare Matrx Vi Cushio Rigidizer 4 Ivacare Matrx PS Cushio/Extra 7 Ivacare Matrx Libra Cushio/Extra 9 Bariatric Cushios 4 Page Ivacare Matrx Vi Heavy Duty Cushio/Extra 5 Ivacare Matrx PS Heavy Duty Cushio/Extra 8 Ivacare Matrx Libra Heavy Duty Cushio/Extra 10 Modificatios & Accessories 4 Page Ivacare Matrx Libra Fit Kit Compoets 11 Cushio Modificatios 12 Cushio Accessories 12 Cushio Hardware FAX: of 12 TRD0368 REV A: 10 Nov 2014
2 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM KID*AB*RA CUSHION: Pediatric Ski Protectio & Positioig Cushio Kid*ab*ra Cushio NOTE: Actual cushio width is ½" arrower tha stated size ad cushio depth is 1" loger tha stated depth due to rear cushio radius. Cushio modificatios are available ad ca be specified o Page 12 QUANTITY q QTY KA1212 Vi 11", 12" 12", 13" $ q QTY KA1214 Vi 11", 12" 14", 15" $ q QTY KA1412 Vi 13", 14" 12", 13" $ q QTY KA1414 Vi 13", 14" 14", 15" $ Kid*ab*ra Extra Outer Cushio Cover (Refer to cushio sizes above for proper fit) Weight capacity up to 150 lbs Comes stadard with ier cover ad Kid*ab*ra outer covers Kid*ab*ra KC REFER TO CUSHION SIZES ABOVE $95.00 KID*AB*RA DROP BASE: Pediatric Ski Protectio & Positioig Cushio Kid*ab*ra Drop Base Cushio NOTE: Base ca oly be ordered with correspodig Kid*ab*ra Cushio Must specify drop hook size: 7/8" or 1" diameter ad 1" or 2" drop QUANTITY q QTY KB1212 Vi 12" 12", 13" $ q QTY KB1214 Vi 12" 14", 15" $ q QTY KB1312 Vi 13" 12", 13" $ q QTY KB1314 Vi 13" 14", 15" $ q QTY KB1412 Vi 14" 12", 13" $ q QTY KB1414 Vi 14" 14", 15" $ DROP HOOKS MOUNTING SPECIFICATIONS: Diameter: q 7/8" q 1" Frot Seat: q FLUSH q 1" q 2" Rear Seat: q FLUSH q 1" q 2" Kid*ab*ra Drop Base Extra (Refer to drop base sizes above for proper fit) Weight capacity up to 150 lbs Icludes dropbase ad moutig hardware KBC REFER TO CUSHION SIZES ABOVE $ FAX: of 12 TRD0368 REV A: 10 Nov 2014
3 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM Vi CUSHION: Stadard Ski Protectio & Positioig Cushio NOTE: Actual cushio width is ½" arrower tha stated size ad cushio depth is 1½" loger tha stated depth due to rear cushio radius. Cushio modificatios are available ad ca be specified o Page 12 Weight capacity up to 300 lbs Comes stadard with ier cover ad outer covers made of Meshtex material Meshtex Startex fabric or smooth fabric side up, Oyx or Fusio Covers are available as a upcharge Vi Cushio QUANTITY q QTY MA1415 Vi 13", 14" 15", 16" $ q QTY MA1417 Vi 13", 14" 17", 18" $ q QTY MA1616 Vi 15", 16" 16", 17" $ q QTY MA1618 Vi 15", 16" 18", 19" $ q QTY MA1620 Vi 15", 16" 20", 21" $ q QTY MA1716 Vi 16", 17" 16", 17" $ q QTY MA1718 Vi 16", 17" 18", 19" $ q QTY MA1720 Vi 16", 17" 20", 21" $ q QTY MA1816 Vi 17", 18" 16", 17" $ q QTY MA1818 Vi 17", 18" 18", 19" $ q QTY MA1820 Vi 17", 18" 20", 21" $ q QTY MA2016 Vi 19", 20" 16", 17" $ q QTY MA2018 Vi 19", 20" 18", 19" $ q QTY MA2020 Vi 19", 20" 20", 21" $ q QTY MA2218 Vi 21", 22" 18", 19" $ q QTY MA2220 Vi 21", 22" 20", 21" $ COVER OPTIONS: SPECIFY: q STARTEX F (Startex Cover Fabric) q STARTEX S (Startex Cover Smooth) $50.00 q OCU MA (Oyx Cover) q FSU MA(Fusio Cover) $ ADD Vi Extra Outer Cushio Cover (Refer to cushio sizes above for proper fit) C REFER TO CUSHION SIZES ABOVE $ *C2218 &C2220 are $ FAX: of 12 TRD0368 REV A: 10 Nov 2014
4 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM Vi DROP BASE: Stadard Ski Protectio & Positioig Cushio NOTE: Base ca oly be ordered with correspodig Matrx Cushio Must specify drop hook size: 7/8" or 1" diameter ad flush 1" or 2" drop Weight capacity up to 300 lbs Icludes dropbase ad moutig hardware Vi Drop Base QUANTITY q QTY MB1415 Vi 14" 15", 16" $ q QTY MB1417 Vi 14" 17", 18" $ q QTY MB1516 Vi 15" 16", 17" $ q QTY MB1518 Vi 15" 18", 19" $ q QTY MB1616 Vi 16" 16", 17" $ q QTY MB1618 Vi 16" 18", 19" $ q QTY MB1716 Vi 17" 16", 17" $ q QTY MB1718 Vi 17" 18", 19" $ q QTY MB1816 Vi 18" 16", 17" $ q QTY MB1818 Vi 18" 18", 19" $ q QTY MB1916 Vi 19" 16", 17" $ q QTY MB1918 Vi 19" 18", 19" $ q QTY MB2016 Vi 20" 16", 17" $ q QTY MB2018 Vi 20" 18", 19" $ DROP HOOKS MOUNTING SPECIFICATIONS: Diameter: q 7/8" q 1" Frot Seat: q FLUSH q 1" q 2" Rear Seat: q FLUSH q 1" q 2" Vi Drop Base Extra (Refer to drop base sizes above for proper fit) BC REFER TO DROP BASE SIZES ABOVE $90.00* Vi CUSHION RIGIDIZER Vi Cushio Rigidizer NOTE: Lightweight plastic seat isert fits betwee seat rails for level support ad elimiates hammock effect of seat upholstery. QUANTITY q QTY CR14S 12" 14" 12" 17" $75.00 q QTY CR16S 15", 16" 15", 16" $75.00 q QTY CR16M 15", 16" 17", 18" $75.00 q QTY CR16L 15", 16" 19", 20" $75.00 q QTY CR18S 17", 18" 15", 16" $75.00 q QTY CR18M 17", 18" 17", 18" $75.00 q QTY CR18L 17", 18" 19", 20" $75.00 q QTY CR20S 19", 20" 15", 16" $75.00 q QTY CR20M 19", 20" 17", 18" $75.00 q QTY CR20L 19", 20" 19",20" $75.00 q QTY CR22M 21", 22" 17", 18" $95.00 q QTY CR22L 21", 22" 19", 20" $ FAX: of 12 TRD0368 REV A: 10 Nov 2014 Recommeded for chairs with slig seat upholstery.
5 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM Vi HEAVY-DUTY CUSHION: Bariatric Ski Protectio & Positioig Cushio NOTE: Actual cushio width is as stated ad cushio depth is 1½" loger tha stated depth due to rear cushio radius. Cushio modificatios are available ad ca be specified o Page 12 Weight capacity up to 600 lbs Comes stadard with ier cover ad outer covers made of mesh material Meshtex Vi Heavy Duty Cushio (Additioal oe week lead time)* MAWWDD Vi REFERENCE CHART BELOW $ D E P T H (DD) W I D T H (WW) 18" 19" 20" 21" 22" 23" 24" 25" 26" 27" 28" 29" 30" 18" x x x x x x x x x x 19" x x x x x x x x x x 20" x x x x x x x x x x 21" x x x x x x x x x x x x x 22" x x x x x x x x x x x x x 23" x x x x x x x x x x x x x 24" x x x x x x x x x x x x x 25" x x x x x x x x x x x x x 26" x x x x x x x x x x x x x Vi Heavy Duty Extra (Additioal oe week lead time)* CWWDD Vi REFERENCE CHART ABOVE $ * Made to order ad o-refudable FAX: of 12 TRD0368 REV A: 10 Nov 2014
6 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM PS CUSHION: Pediatric Positioig Cushio NOTE: Actual cushio width is ½" arrower tha stated size ad cushio depth is 1" loger tha stated depth due to rear cushio radius. Cushio modificatios are available ad ca be specified o Page 12 (cover will be o-reversible) Weight capacity up to 150 lbs Comes stadard with ier cover ad reversible Startex outer covers Startex No charge outer cover optios: Kid*ab*ra, Pik or Blue (all o-reversible) PS Cushio Kid*ab*ra Pik Blue QUANTITY q QTY PS1010 9", 10" 10", 11" $ q QTY PS1012 9", 10" 12", 13" $ q QTY PS1014 9", 10" 14", 15" $ q QTY PS ", 12" 12", 13" $ q QTY PS ", 12" 14", 15" $ q QTY PS ", 12" 16", 17" $ q QTY PS ", 14" 12", 13" $ q QTY PS ", 14" 14", 15" $ q QTY PS ", 14" 16", 17" $ COVER OPTIONS: SPECIFY: q Startex q Kid*abra q Pik q Blue PS Extra (Refer to cushio sizes above for proper fit) PSC REFER TO CUSHION SIZES ABOVE $85.00* COVER OPTIONS: SPECIFY: q Startex q Kid*abra q Pik q Blue FAX: of 12 TRD0368 REV A: 10 Nov 2014
7 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM PS CUSHION: Stadard Positioig Cushio PS Cushio NOTE: Actual cushio width is ½" arrower tha stated size ad cushio depth is 1" loger tha stated depth due to rear cushio radius. Cushio modificatios are available ad ca be specified o Page 12 (cover will be o-reversible) QUANTITY q QTY PS ", 16" 16", 17" $ q QTY PS ", 16" 18", 19" $ q QTY PS ", 16" 20", 21" $ q QTY PS ", 18" 16", 17" $ q QTY PS ", 18" 18", 19" $ q QTY PS ", 18" 20", 21" $ q QTY PS ", 20" 16", 17" $ q QTY PS ", 20" 18", 19" $ q QTY PS ", 20" 20", 21" $ PS Extra (Refer to cushio sizes above for proper fit) Weight capacity up to 300 lbs Comes stadard with ier cover ad reversible Startex outer cover Startex PSC REFER TO CUSHION SIZES ABOVE $85.00* FAX: of 12 TRD0368 REV A: 10 Nov 2014
8 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM PS HEAVY-DUTY CUSHION: Bariatric Positioig Cushio NOTE: Actual cushio width is as stated ad cushio depth is 1" loger tha stated depth due to rear cushio radius. Weight capacity up to 600 lbs Comes stadard with ier cover ad Startex o-reversible outer covers; specify fabric or smooth side out optio PS Heavy Duty Cushio (Additioal oe week lead time)* PS Heavy Duty Extra (Additioal oe week lead time)* PSWWDD REFERENCE CHART BELOW $ STARTEX COVER: q Fabric side up q Smooth side up D E P T H (DD) Startex W I D T H (WW) 21" 22" 23" 24" 25" 26" 27" 28" 29" 30" 30" 16" x x x x x x x x x x x 17" x x x x x x x x x x x 18" x x x x x x x x x x x 19" x x x x x x x x x x x 20" x x x x x x x x x x x 21" x x x x x x x x x x x 22" x x x x x x x x x x x 23" x x x x x x x x x x x 24" x x x x x x x x x x x 25" x x x x x x x x x x x 26" x x x x x x x x x x x 27" x x x x x x x x x x x 28" x x x x x x x x x x x 29" x x x x x x x x x x x 30" x x x x x x x x x x x PSCWWDD REFERENCE CHART BELOW $ STARTEX COVER: q Fabric side up q Smooth side up * Made to order ad o-refudable FAX: of 12 TRD0368 REV A: 10 Nov 2014
9 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM LIBRA CUSHION: Stadard Adjustable, Ski Protectio Cushio NOTE: Actual cushio width is as stated ad cushio depth is 1½" loger tha stated depth due to rear cushio radius. Weight capacity up to 300 lbs Comes stadard with foam base, fluid sac, platilo ier lier ad Startex outer cover Libra Cushio Startex QUANTITY q QTY LC " 12" $ q QTY LC " 14" $ q QTY LC " 16" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ q QTY LC " 16" $ q QTY LC " 18" $ q QTY LC " 20" $ Libra Extra (Refer to cushio sizes above for proper fit) LCC/LSC REFER TO CUSHION SIZES ABOVE $ COVER OPTIONS: SPECIFY: q LCC Startex q LSC Spacer Mesh FAX: of 12 TRD0368 REV A: 10 Nov 2014
10 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM LIBRA HEAVY-DUTY CUSHION: Bariatric Adjustable, Ski Protectio Cushio NOTE: Actual cushio width is as stated ad cushio depth is 1½" loger tha stated depth due to rear cushio radius. Weight capacity up to 500 lbs Comes stadard with foam base, fluid sac, platilo ier lier ad Startex outer cover Libra Heavy Duty Cushio Startex QUANTITY q QTY LC " 17", 18" $ q QTY LC " 19", 20" $ q QTY LC " 21", 22" $ q QTY LC " 17", 18" $ q QTY LC " 19", 20" $ q QTY LC " 21", 22" $ q QTY LC " 19", 20" $ q QTY LC " 21", 22" $ q QTY LC " 19", 20" $ q QTY LC " 21", 22" $ Libra Heavy Duty Extra (Refer to cushio sizes above for proper fit) 4 HCPCS Code: E2619 LCC/LSC REFER TO CUSHION SIZES ABOVE $ COVER OPTIONS: SPECIFY: q LCC Startex q LSC Spacer Mesh FAX: of 12 TRD0368 REV A: 10 Nov 2014
11 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM LIBRA FIT KIT COMPONENTS & OTHER COMPONENTS: Libra Compoets QUANTITY MODEL COMPONENT MSRP q QTY LAB Libra Adbuctor $ " Abductor built up Top mouted q QTY FTSW Seat Wedge $ " Aterior wedge icreases pre ischial cotour Uderside mouted q QTY FTHD Hemi Wedge $ " Aterior thigh support Uderside mouted q QTY FTTW LFRR Tapered Wedge LFRR $50.00 ¾" Tapered wedge for users s Left frot or Right rear Uderside mouted q QTY FTTW LFLR Tapered Wedge LFLR $50.00 ¾" Tapered wedge for users s Right frot or Left rear Uderside mouted q QTY LFS Libra Fluid Supplemet $50.00 May be used to accommodate mild pelvic obliquity/additioal pressure reductio q QTY FTLW Lateral Wedge $ " Lateral wedge icreases hip/thigh loadig, Uderside mouted q QTY CLCFP Complete Libra Cushio Fluid Sac $ SPECIFY CUSHION SIZE: WIDTH DEPTH q QTY LCPL WWDD Platilo Ier Lier $35.00 SPECIFY CUSHION SIZE: WIDTH DEPTH FAX: of 12 TRD0368 REV A: 10 Nov 2014
12 INVACARE CUSHIONS INTERNATIONAL PRICE LIST/ORDER FORM CUSHION MODIFICATIONS: NOTE: Rear Cushio radius icluded o all PS, VI & Libra Cushios. Notes: LEFT SIDE LEG LENGTH DISCREPENCY SEAT WITDTH REDUCTION RIGHT SIDE Modificatios (Additioal oe week lead time) SEAT DEPTH REDUCTION ACCESSORIES & HARDWARE: QUANTITY MODEL COMPONENT MSRP q QTY SDR Seat Depth Reductio $ Less: q 1" q 2" q 3" q 4" Specify q QTY SWR Seat Width Reductio $ Less: q 1" q 2" q 3" q 4" Specify q QTY LLDR Leg Legth Discrepacy Right $ Less: q 1" q 2" Specify q QTY LLDL Leg Legth Discrepacy Left $ Less: q 1" q 2" Specify q QTY ECM Modificatio $50.00 Accommodates LLDL/LLDR/SDR/SWR q QTY MAC Miscellaeous Modificatio $ Please use a diagram above to idicate required modificatios Requires approval QUANTITY MODEL COMPONENT MSRP q QTY CIC Extra Ier Cover $ " Pelvic Obliquity built up Top mouted q QTY NSF No Stadard Fabric Selectio $75.00 Available for Cushios/bases; excludig Flo tech & Libra q QTY POK Pelvic Obliquity Kit $50.00 Accommodates ½ ad Obliquities q QTY BDH0 Base Drop Hooks (pair) $27.00 Flushmout (0) drop for 7 /8 or 1 Diameter q QTY BDH1 7 /8 Base Drop Hooks (pair) $ Drop for 7 /8 Diameter q QTY BDH2 7 /8 Base Drop Hooks (pair) $ Drop for 7 /8 Diameter q QTY BDH1 1 Base Drop Hooks (pair) $ Drop for 1 Diameter q QTY BDH2 1 Base Drop Hooks (pair) $ Drop for 2 Diameter q QTY BDC Dura Clip (pair) $60.00 Top lock retractable hardware for use with Drop Hooks q QTY BFC FixClip (pair) $25.00 Top lock hardware for use with Drop Hooks FAX: of 12 TRD0368 REV A: 10 Nov 2014
q Icon TM Backs (Low, Mid, Tall, Deep ) $ q Evolution TM Backs (Regular, Tall, Deep ) $
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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. Effective 05/14/2018 Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: q Catalyst
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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
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More informationFrame 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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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. Phone (800) 981-1540 Fax (715) 254-0996 Company: Account Number: Date: q Quote q PO Number: RTS:
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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:
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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:
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More informationPrescription 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
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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
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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
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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 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,
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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
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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
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