q PG Controller $700 E2377 q Harness for Expandable Controller $350 E2313 q Remote Plus 3-Key $700 q1 Profile q Multiple Profile

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1 Jazzy 1113ATS Discount: Terms: Freight: Taken By: Order Form 300lb Wt Cap Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA Phone: (866) Fax: (866) Account Number: Provider Name: Contact: Phone: Fax: Date: PO#: Marked For: Ship To Address: City: State: Zip: DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered as legal advice. All prices are MSRP. BASE MODEL EXPANDABLE CONTROLS q Jazzy 1113ATS 2SP-SS $6,251 K0835 q Jazzy 1113ATS 2SP-C $6,251 K0836 COLOR q Champagne q Candy Apple Red $52 q Viper Blue $52 q Onyx Black $52 DRIVE WHEEL q Pneumatic q Flat Free $213 q 9.55 D q D NON-EXPANDABLE CONTROLS BATTERIES (INSTALLED) q U-1, 32 Amp $133 ea. E2365 q 4 Amp Onboard Charger q 8 Amp Off-board Charger $360 q P&G VSI, 70 Amp BASE MOUNTED FOOT PLATFORM BATTERY CHARGER All Joysticks or Omni Plus must be used in conjunction with PG Controller and Harness for Expandable Controller q PG Controller $700 E2377 q Harness for Expandable Controller $350 E2313 q Remote Plus 3-Key $700 q1 Profile q Multiple Profile With Switch Jacks With Speed Dial With Toggles q Remote Plus 3-Key, $700 With Environmental Controls q1 Profile q Multiple Profile q Remote Plus 3-Key, With Toggles $700 And Environmental Controls 1 q Remote Plus 3-Key, With Switch $700 Jacks And Environmental Controls 1 q P&G 6-Key VSI, 70 Amp $200 q Microdrive Joystick 1 $ with 5 individual drive profiles. PROGRAMMER q P&G Programmer $423 Revised: August 14, 2012 Page 1 of 5

2 Jazzy 1113ATS Group 2 Order Form JOYSTICK MOUNTS Comes with a Quick Release, Adjustable-Height Joystick Block q Fixed Inline q Swing-away $210 E1028 Style: q Inline q Offset Length: q 4 Ext. q 7 Ext. 1 q Multi-axis Fixed $100 K In iquantum choose in addition to Swing-Away 4 mount. JOYSTICK HANDLES q Carrot Handle q Mushroom Handle $71 E2323 q T-Bar $107 E2323 q Chin Cup $71 E q Extended I-Handle $71 E2323 q Soft Ball Handle $50 E2323 q Medium Ball Handle $50 E2323 q Bodypoint 3 Goal Post Handle $66 E2323 q Bodypoint 4 Goal Post Handle $66 E Use HCPCS code E2323 when not used in conjunction with a chin control. SPECIALTY SEATING Specialty Seating Kit Seat Depth: Back Cane Height: Back Rest Height: Armrests: 2-Post, Fixed, Flip Back 1 Flip-Back, Cane Mounted 1 $95 ea. Removable, Adjustable, Quick Height 2 $275 ea. E0973 Removable, Single-Post, Fixed Height Adjustable Heavy Duty $150 ea. E Adjustment Adjustment q Pediatric, Removable 3 $275 E0973 Color: Match Shroud Black Quad Release Lever Armpads: Left: Full Length Desk Length Right: Full Length Desk Length 1. Swing-away Laterals Interfere with flip-back arms. Call for configuration with Shape back. 2. Adjustable from 11 to 17 H in 1/2 increments. 3. Height adjustable from in 1/2 increments. Full length armpads not available. CONTOURED SEATING High Back: 1 Limited Recline High-Back with Headrest & $275 Solid Seat Pan Seat Depth : Upholstery: Black Vinyl Depth Adjustable High Back: Limited Recline Depth Adjustable $275 High Back w/ Headrest 1 Color: Gray Vinyl Black Vinyl Size: 18 W x D 20 W x D Towers: Tall Seat Mounts (Increases STF Height 2 ) Armrests: Flip-Up, Removable Flip-Up, Height-Adjustable, Removable $85 ea. E0973 Armpads: Left: Full Length Desk Length Right: Full Length Desk Length Special Order Seat W x D Seat size can not exceed 20 W x 20 D $450 MSRP 1. Seat comes automatically with a 60 belt. Requires Full Length Arms. SYNERGY SEATING SYSTEMS q Synergy Seating Frame $434 q Synergy Manual Tilt Package 1 $434 E0108 Max. Seat Size 14 W x 14 D, 75 lbs Weight Capacity 1. In i-quantum this option is chosen under Width Package Type. SEATING SPECIFICATIONS q 10 q 11 q 12 q 13 q 14 q 15 q 16 q 17 q 18 q 19 q 20 Seat Width Package: q 10 W-14 W q 14 W-18 W q 16 W-20 W Seat Depth: q 10 q 11 q 12 q 13 q 14 q 15 q 16 q 17 q 18 q 19 q 20 Seat Depth Package: q 10 D-14 D q 14 D-18 D q 15 D-20 D Back Cane Height: q 14 q 15 q 16 q 17 q 18 q 19 q 20 q 21 q 22 q 23 q 24 q 25 BACK OPTIONS Synergy Back: q Synergy Shape Back Positioning Back Various E2613/E2614 See Synergy Shape Back Order Form For Detailed Pricing, Sizes and Codes q Omit Back q Sling Back $98 q Synergy Back with 1.5 Thick Back Cushion $275 Overall Back q 18 H q 19 H q 20 H q 21 H Height: q 22 H q 23 H q 24 H q 25 H Choose Lateral Extensions: q 6 for H Back $25 q 10 for H Back $25 q 12 For H Back $25 q 16 For H Back $25 Revised: August 14, 2012 Page 2 of 5

3 Jazzy 1113ATS Group 2 Order Form BACK OPTIONS (CONT D) ARMPADS q TRU-Comfort Back 4-way Stretch Material Cover Width: q 16 W q 18 W q 20 W $595 E2620 New Design! Overall Back q 20 H q 21 H q 22 H q 23 H Height 1 : q 24 H q 25 H q 27 H q 28 H Width: q 17 W q 19 W $595 E2620 Overall Back q 22 H q 23 H q 24 H q 25 H Height 1 : q 27 H q 28 H Width: q 22 W 2 q 24 W 2 $695 E2621 Overall Back q 24 H q 25 H q 27 H q 28 H Height 1 : Tru Comfort Color Shroud Option: q Black ( color option) Metallic Colors:$100 Solid Colors:$100 q Champagne Mariner Blue q Candy Apple Red Cardinal Red q Viper Blue Spring Green q Sunburst Orange Solar Yellow q Pearl Pink Violet q Silver Tangerine q Pewter Gray Kelly Green q Emerald Green q Graphite Blue q Sapphire Blue q Straight, Full Length (2 x14 ) q Straight, Desk Length (2 x10 ) q Waterfall, Full Length (2 x14 ) q Waterfall, Desk Length (2 x10 ) q Falcon Gel, Full Length, (3.5 x14 )* qleft qright qfull Length Gel Armpad Mounting Plate (Required)* q Falcon Gel, Desk Length, (3.5 x10 )* qleft qright qdesk Length Gel Armpad Mounting Plate (Required)* LAP BELTS q 38 Lap Belt q 50 Lap Belt q 70 Lap Belt q 80 Lap Belt q 90 Lap Belt HEADRESTS $160 pr. $56.69 ea. $125 pr. $53.52 ea. Back Options: q Back Canes q Omit Push Handles $125 q Flip Forward Back Canes 3 $150 q Omit Push Handles $125 q Offset (Meso) 4 $195 q 2 (1 Per Side) q 4 (2 Per Side) q Inset (Endo) 4 $195 q 2 (1 Per Side) q 4 (2 Per Side) 1. Overall Back height measurement is measured from the seat pan to the top of the back, +/- 1/2. 2. Available with offset (meso) brackets. 3. Not available with O2 Holder. May interfere with Lateral Supports and Waterfall Armpads. 4. Dual Post Flip-back Armrests interfere with offset canes. SYNERGY ARMRESTS Synergy Armrests: q Flip Back, Cane Mounted Armrests 1 q 2-Post, Flip-back, Height Adjustable, $150 ea. E0973 Removable 2 q Single Post Height Adjustable Removable 3 $75 ea. E0973 q Quad Release Lever q Removable, Single Post, Height Adjustable, Heavy Duty $75 ea. E0973 Height: q 8 H - 12 H q 10 H - 14 H q Pediatric, Removable 4 $75 ea. E0973 Color: q Black q Match Shroud q Quad Release Lever q Height Adjustable Cantilever Armrests 5 $195 K0020 Angle Adjustable: -30 o through +30 o q No Headrest Required TRU-Comfort Headrest 1 : q 8 W Leatherette $205 E0955 q 8 W TRU-Comfort Plus $205 E0955 q 10 W Leatherette $205 E0955 q 10 W TRU-Comfort Plus $205 E0955 q Removable Headrest Bracket $210 E1028 Stealth: q Small (9.75 W x 3 H) (STL-OTSM250) $205 E0955 q Large (11 W x 6 H) (STL-OTLG150) $205 E0955 q Pediatric Comfort Plus (6 W) (CPN350) $142 E0955 q Small Comfort Plus (10 W) (CP250) $142 E0955 q Large Comfort Plus (14 W) (CP150) $142 E0955 q Removable Headrest Bracket 2 (HMO475P) $210 E1028 q Swing-away (Flip-down) Headrest $210 Bracket (FDM350) Used in Addition to Removable Headrest Bracket Aftermarket Bracket: q Stealth s World s Best Removable Headrest $210 E1028 Hardware (TWB485) 1. Measurement is taken from the inside of the headrest. 1. Interferes with Swing-Away laterals. 2. Height adjustment from 9-13 in 1 increments. Interferes with swing-away laterals. Not available with a depth less than Height adjustable from in 1/2 increments. 4. Height adjustment form in 1/2 increments. Not available with full length armpads. 5. Height adjustment from depends on cane height. Not available with Flip Forward Back Canes, Cane Clamp Pushbar, or Shape Back. Call for details when selecting after market arm troughs. Revised: August 14, 2012 Page 3 of 5

4 Jazzy 1113ATS Group 2 Order Form NON-POWERED LEGRESTS ADJUSTABLE CENTER MOUNT FOOT PLATFORM New! q 70 o Swing-away Legrests 1 $162 q Straight q Tapered q Extruded Footplates Extruded Extensions: q q q Extruded Footplates: q 7.25 x 6 q 8.5 x 6 q Angle-Adjustable Footplates 2 $150 Angle Adjustable Extensions: q q q Angle-Adjustable Footplates: q 4 x 6 q 5 x 6 q 5 x 8 q 6 x 8 3 q 6 x 11 4 q 8 x 11 4 q Multi-Axis Footplates $495 Multi-Axis Extensions: q q Multi-Axis Footplates: q 4 x 6 q 5 x 6 q 5 x 8 q 6 x 8 4 q 6 x 11 4 q 8 x 11 5 q High Mount, Clamp-On Footrest* q Angle Adjustable q Small, 4 x 7.75 $356 q Large, 4.25 x 9.25 $356 q Multi-Axis q Small, 4 x 7.75 $456 q Large, 4.25 x 9.25 $460 q Heavy Duty Drop-In Legrests 1,5 $420 q Angle Adjustable Footplates 2 $150 q q K0040 K0040 q Elevating Legrests 1 $325 K0195/E0990 q Footplates Extruded Extension Length: q11-14 q14-17 Extruded Footplate Size: q7.25 x 6 q8.5 x 6 q Angle Adjustable Footplates 2 $150 q q q Calf Pad Adjustment q1 Hole q3 Hole q6 Hole q 90 o Pediatric Swing-Away Legrests 1 $162 q Angle Adjustable Footplate 2 q 7-10 q 4 x 6 q 5 x 6 1. Legrest Extensions are measured from seatpan to footplate. 2. Includes Heel Loops 3. Causes interference on seat widths less than Causes interference on seat widths less than Only available on Synergy Seating. q Adjustable Center Mount Foot Platform 1 $250 Includes 10 W x 11 D Split Foot Platform Extensions: 2 q 8-12 Ext. q Ext Calf Supports 3 : q Calf Pads (pair) $150 q Small (6 H x 6 W) Optional Modular Footplate Extension Components/Kits.3,4 q 4 Width Extension Kit $50 q 2 Bell Shaped, Length $50 Extension Kit q 4 Width Extension with 2 Bell $75 Shaped, Length Extension Kit q 6-Piece Extension Stock Kit $95 (Includes all above pieces) Additional Optional Accessories 3 : q Footplate Connector $49 1. Only available on Synergy Seating. 2. Extension length is measured from top of the seat pan to footplate. 3. Choose in Rigging Accessory Section in iquantum. 4. Assembly required. May require seating configuration adjustments to avoid front caster interference. ELECTRONICS FOR POWER LEGRESTS Power Front Riggings Require Remote+ Electronics q Independent Legs Through Remote+ $2,375 E2311 POWERED LEGRESTS q70 o Articulating Swing-Away Legrests, $2,395 E Articulation Range 1 qquad Release Lever Calf Pads 2 : q6 x 5.35 q8 x 5.86 Angle Adjustable Extension Length 3 : q11-13 q Operational Method: qindependent qcombined q70 o Articulating Drop-In Legrests 1 $2,395 E1010 Angle: q70 o q80 o Range: q4 Range q6 Range Calf Pads 2 : q6 x 5.35 q8 x 5.86 Angle Adjustable Extension Length 3 : q q Operational Method: qindependent qcombined 1. Available only on Synergy seating. 2. Choose in Rigging Accessory Section in iquantum. 3. Extension length is measured from top of the seat pan to footplate. 4. Causes interference on seat widths less than Causes interference on seat widths less than 20. Revised: August 14, 2012 Page 4 of 5

5 Jazzy 1113ATS Group 2 Order Form SYNERGY CUSHIONS q No Cushion Required Please refer to Synergy order forms for detailed pricing, sizes and codes. Simplicity Cushion General Use q 16 x x 20 $98 E2601 Solution 1 Cushion Skin Protection: q 14 x x 18 $380 E2603 q 20 x 20 $430 E2603 Solution Cushion Skin Protection & Positioning q 10 x x 18 $380 E2607 q 20 x 20 $430 E2607 Spectrum Gel Cushion Positioning q 12 x x 19 $480 E2605 q 20 x 20 $530 E2605 Spectrum Visco Cushion Skin Protection & Positioning q 10 x x 18 $480 E2607 q 20 x 20 $530 E2607 Spectrum Air Cushion Adjustable Skin Protection q 14 x x 20 $480 E2622 Spectrum Air Contour Cushion Adjustable Skin Protection & Positioning q 14 x x 20 $499 E2624 TRU-Comfort Seat Cushion General Use Includes Allure leather-like cover q 16 x x 20 $380 E2601 TRU-Comfort Plus Seat Cushion Skin Protection Includes 4-way stretch material cover q 16 x x 20 $380 E2603 FRONT RIGGING ACCESSORIES q Wheel Bumpers $25 q Heel Loops (pair) 1 $38 E0951 q Gel Neoprene Footrest Sleeve (pair) 2 $65 K0108 q ELR/ALR Adductor Buttons (pair) $125 K0108 q POSAlinc Knee Adductor for $256 K0108 Swing-Away Legrests (pair)* q POSAlinc Rail Mounted Knee Adductor (pair) * $287 K0108 q Residual Limb Support $300 E1020 Bodypoint Ankle Huggers (pair)* $134 K0108 q Small q Medium 1. with Angle Adjustable or Multi-Axis footplates. 2. Only available with Swing-Away legrests. LATERALS (SYNERGY ONLY) q Stealth Thoracic Laterals (pair) 1 * Bracket: q Swing-Away Rail Mounted $450 E1028 For Use on Synergy Back and Tru-Comfort (Synergy and Tilt Only) q Flat Pad, 3 x5, Leather-Like Cover $200 E0956 q Flat Pad, 4 x6, Leather-Like Cover $200 E0956 q Curved Pad, 2 x3, 4-Way Stretch Cover $200 E0956 q Curved Pad, 3 x5, 4-Way Stretch Cover $200 E0956 q Curved Pad, 4 x6, 4-Way Stretch Cover $200 E0956 q Stealth Pelvic/Thigh Laterals* q Left Side q Right Side Bracket: q Removable Bracket (ea.) $250 E1028 q Removable Bracket w/ 1 Offset (ea.) $325 E1028 q Flip Down Bracket (ea.) $225 E1028 q Short Pad, 4 x4 (ea.) $90 E0956 q Medium Pad, 4 x8 (ea.) $90 E0956 q Long Pad, 4 x12 (ea.) $90 E0956 Adapter: q2 Depth/Height Adapter Plate (ea.) 2 $25 K0108 q Therafin Flip-down Knee Abductor Bracket* $172 E1028 q Small q Medium q Large $135 E0957 Stealth Foot Boxes (pair)* $475 K0108 q Small q Medium q Large q Stealth Padded Shoe Holders (pair)* $166 K0108 q Small q Medium q X-Large q Otto Bock Arm Channels (ea.)* $104 E2209 Size: q Small q Medium q Large q Otto Bock Flat Hand Pad(ea.)* $52 Size: q Medium q Large Please see positioning components order form for additional types, sizes and details. Rear Basket 1 $103 Cane/Crutch Holder 1 $98 E2207 Weather Cover, Medium, Black $158 q Cup Holder $17 2 qleft qright 1. Swing-away Laterals Interfere with flip-up armrests. 2. Height adaper plate is needed w/ Tru Comfort seat cushion. Not available on the flip down bracket. MISCELLANEOUS POSITIONING COMPONENTS (SYN ONLY) ACCESSORIES Saddle Bag $28 Flag Holder 1 $17 Quantum Backpack 3 $60 Oxygen Holder Contoured Seating 1 $103 E2208 q Oxygen Holder Synergy Seat 4 $150 E2208 Walker Holder 1 $92 K0108 q Tablet Holder 5 $315 q Deluxe Cell Phone/Media Holder 5 $140 q Cell Phone/Media Holder 5 1. Includes mounting hardware. Not available on Manual Recliner. 2. No charge with Synerg Seating. 3. Backpack may interfere w/ other rear accessories. Not available w/ contoured seating. 4. Not available with Synergy Manual Tilt. Includes mounting hardware. 5. Only available with Synergy or Specialty seating. SEAT TO FLOOR HEIGHTS Seating System Seat-To-Floor Height Contoured Seat Specialty Seat Synergy Seat ( Stem Mounts) Seat to floor height are +/- 1/8 with 18 W x 18 D with Flat-Free tires (add 3/8 for pneumatic tires). Increased widths may increase lowest seat to floor heights. Revised: August 14, 2012 Page 5 of 5