nrg recliner order form april 1

Document Sample
nrg recliner order form april 1 Powered By Docstoc
					                                NRG+ RECLINER ORDER FORM                                                         APRIL 1, 2012
CUSTOMER NAME                                                      AUTHORIZER NAME
ADDRESS                                                            REFERENCE #
CITY                              PROVINCE                         PHONE #
POSTAL CODE                       DATE                             A.A.D.L.CODE W276

                                        STANDARD FEATURES                                             PRICE: $2295.00
        BLACK OR      CHROME FRAME COLOUR – NO CHARGE
                                                                               STRONG EASY TO CLEAN NYLON UPHOLSTERY
        BURGUNDY,      PURPLE,    BLUE OR GREEN                               MULTIPLE VERTICAL AXLE POSITIONS
       POWDER COATED FINISH FRAME COLOURS ($250)                               24” BACK HEIGHT INCLUDING HEAD REST
     WEIGHT CAPACITY 250 LBS                                                  11” HEAD REST EXTENSTION
     LIGHT WEIGHT & DURABLE 18” DEEP CHROMOLY FRAME                           SWING AWAY ELEVATING LEGREST & ANTI TIPPERS
     DUAL GAS STRUTS FOR RECLINE                                              PRECISION BEARINGS

                                                        ORDER CODE
SERIES     SEAT                    ARM TYPE                         FOOTREST/               UPHOLSTERY COLOR               CHAIR SIZE
           HEIGHT                                                  LEGREST PAIR                  (NYLON)                   W        D

                                                                                                                     14          14-$350
NPR                                                                                         U1       BLACK
           T 21.0”
                                                                 FOOTREST
                        A1                                                                                           15          15-$350
                        FULL LENGTH NON ADJ. HT.                E1 -  ELEVATING             U2       WINE
           S 19.5”
                                                                      & ALUMINUM                                     16
           MH18.5       A2                                      FOOTPLATE (STD)             U4     NAVY BLUE                     16
                        DESK LENGTH NON ADJ. HT.                                                                     17          17
           H 17.5”                                              F1 –   60° (N/C)            U5     BRIGHT BLUE
                        A3                                             70° (N/C)                                     18
           LH 16.5”     FULL LENGTH ADJ. HEIGHT $240                                                                             18
                                                                       80° (N/C)            U7     FOREST GREEN
                                                                       90° ($180)                                    19
           L 15.25”     A4                                                                                                       19-$350
                                                                F180/90 REQUIRE
                        DESK LENGTH ADJ. HEIGHT $240                                        U8     PLUM
                                                                AAF/ F2 W8”CASTERS                                   20

           SL 14.5”     A3L                                                                                          21-$450    20-$350
                                                                PLASTIC                     UC
                        FULL LENGTH ADJ. HEIGHT                 FOOTPLATES                  CUSTOM COLOUR
                        (LOW)                                                               $150                     22-$450     21-$350
                        $240
                                                                  F5 ANGLE ADJ
           REFER TO     (Requires Low STF with 20” or 22”
                                                                FOOTREST ($240)                                                 22-$350
                        Wheels)                                                                                      23-$450
            WHEEL
            MATRIX                                              FOOTPLATES
              ON                                                                                                     24-$450
                                                                          F2 ALUMINUM
            SECOND
             PAGE
                                                                         XLF EXTRA
                                                                        LARGE($120)

                                                                         AAF ANGLE
                                                                        ADJUSTABLE
                                                                         ($240)


                                                            SEATING
                                                                               KYPHOTIC          KYPHOTIC      SHALLOW U       SHALLOW U
                                           SHALLOW U          DEEP U            DEEP U           DEEP U           ($832)          ($832)
                                             ($544)            ($608)            ($832)           ($832)        KYPHOTIC        KYPHOTIC
                                                                                              TALL                             TALL
      CUSHIONS / BACKS                      MAX($624)
                                                             MAX ($784)
                                                             COMFORT          COZY ($480)
                                                                                            CUSHIONAIR       CUSHIONAIR      CUSHIONAIR
                                                                                                HIGH                            2 OR  4
                                           COMFORT          BARIATRIC          CUSHION       PROFILE            LOW            VAVLE
                                                                                                               PROFILE
                                            MAHM – MULTI AXIS WITH MOULDED H/R              NOTES:
                                                          $460
          HEAD RESTS                       MAHF – MULTI AXIS WITH FABRICATED H/R
                                                          $460
                                                WWW.mapleleafwheelchair.com

6540 Tomken Road, Mississauga, Ontario, L5T 2E9 Tel.: (905) 564-2250, (800) 362 0873 Fax (905) 564-5424
                                                                                                         .




               NRG+ RECLINER SEAT TO FLOOR MATRIX, OPTIONS AND ACCESSORIES
                     HEMI FRAME                     REAR WHEEL          CASTER                   FORK                  DUMP
                      SL 14.50"                         20"               5"                   XL SHORT                .75"
                       L 15.25"
                                                        20"               5"                    SHORT                  .75"
                       L 15.25"                         20"               6"                    SHORT                  .75"
                       L 15.25"                         22"               5"                    SHORT                  .75"
                       L 15.25"                         22"               6"                    SHORT                  .75"
                       LH 16.5"
                                                        22"               6"                  SHT/LONG                 .75"
                       H 17.5"                          22"               6"                    LONG                   .75"
                       H 17.5"                          22"               8"                    LONG                   .75"
                       H 17.5"                          24"               6"                    LONG                   .75"
                       H 17.5"                          24"               8"                    LONG                   .75"
                      MH 18.50"                         24"               8"                    LONG                   .75"
                  STANDARD FRAME
                      MH18.50"                          22"               6"                    LONG                   .75"
                      MH 18.50"
                                                        22"               8"                    LONG                   .75"
                       S19.50"                          24"               8"                    LONG                   .75"
                       T 21.00"                         24"               8"                    LONG                   .75"


PART #                    DESCRIPTION               PRICE        PART                          DESCRIPTION                   PRICE     
                       SEAT & UPHOLSTERY                          #                       WHEELS AND CASTERS
                                                                  20U            20” X 1 3/8” TREADED URETHANE TIRE           $120.00
SDF14          SEAT DEPTH BY FRAME 14”              $350.00       22S            22” X 1” PYRAMID URETHANE TIRE                 N/C
SDF16          SEAT DEPTH BY FRAME 16”              $350.00       22U            22” X 1 3/8” TREADED URETHANE TIRE            $88.00
SDF17          SEAT DEPTH BY FRAME 17”              $350.00       22AT           22” X 1 3/8” AIR TIRE                         $88.00
SDF19          *SEAT DEPTH BY FRAME 19”             $350.00       22CH           22” CHROME HANDRIMS                            N/C
SDF20          *SEAT DEPTH BY FRAME 20”             $350.00       24S            24” X 1” PYRAMID URETHANE TIRE                 N/C
HDS            HEAVY DUTY SEAT UPHOLSTERY           $76.00        24U            24” X 1 3/8” TREADED URETHANE TIRE            $88.00
XHDS           EXTRA HD SEAT UPHOLSTERY             $88.00        24AT           24” X 1 3/8” AIR TIRE                         $88.00
SSI            SOLID SEAT POCKETED INSERT           $94.00        24CH           24” CHROME HANDRIMS                            N/C
SDB            SOLID DROP BASE                      $176.00       PCH            PLASTIC COATED HANDRIMS                      $120.00
VU             VINYL UPHOLSTERY                     $75.00        QRA            QUICK RELEASE AXLE (7/16”)                   $120.00
                        BACK & UPHOLSTERY                         BRX6           BRAKE EXTENSION 6”                            $40.00
HDBK           HEAVY DUTY BACK UPHOLSTERY           $76.00        BRX9           BRAKE EXTENSION 9”                            $60.00
XDBK           EXTRA HD BACK UPHOLSTERY             $88.00        SPUS           STEEL PUSH TO LOCK BRAKE                       N/C
SLBK           SLACK BACK UPHOLSTERY                $60.00        SPUL           STEEL PULL TO LOCK BRAKE                       N/C
CBK            CAPPED BACK UPHOLSTERY               $45.00        APUS           ALUMINUM PUSH TO LOCK                          N/C
SBI            SOLID BACK POCKETED INSERT           $94.00        APUL           ALUMINUM PULL TO LOCK                          N/C
RSH            REMOVABLE STROLLER HANDLE            $150.00                                                  CASTERS
CM6            ONE PIECE FLIP UP FOOT BOARD         $80.00        C51            5” X 1.25” SOLID CASTER ASSEMBLY               N/C
NPLS           NYLON PADDED LEG STRAP               $60.00        C61            6” X 1.25” SOLID CASTER ASSEMBLY               N/C
                                                                  C6U            6” X 1.75” SOLID CASTER ASSEMBLY             $110.00
                                                                  C6A            6” X 1.25” AIR TIRE ASSEMBLY                 $86.00
                                                                  C8U            8” X 1.75” SOLID CASTER ASSEMBLY              $86.00
                       SAFETY ACCESSORIES                         C8A            8” X 1.25” AIR TIRE ASSEMBLY                  $76.00
ASB            AUTO SEAT BELT                        $23.00       C8A2           8” X 2” AIR TIRE ASSEMBLY                    $110.00
VSB            VELCO SEAT BELT                       $23.00                                       MODIFICATIONS
PSB            PLASTIC SEAT BELT                     $23.00       CM13           DOUBLE CROSSBRACE                            $160.00
ATR            ANTI TIPPER ROLLERS (STANDARD)         $N/C        CM15           REINFORCED FOOTREST PINS                      $60.00
                        OTHER ACCESSORIES                                                                    TRAYS
CCH            CRUTCH AND CANE HOLDER                $60.00       WTA          WHEELCHAIR TRAY ASSEMBLY                       $240.00
02H            OXYGEN TANK HOLDER                   $190.00       LPLT         ½ LAP TRAY LEFT SIDE (PADDED)                  $240.00
IVA            I.V. POLE (ADJUSTABLE)               $130.00       RPLT         ½ LAP TRAY RIGHT SIDE (PADDED)                 $240.00
IVNA           I.V. POLE (NON ADJUSTABLE)           $110.00       CPT          CLEAR PLASTIC TRAY                             $280.00
                                                                  HCPT         ½ CLEAR PLASTIC TRAY                           $260.00
                                                                  PWA          PADDED TRAY ASSEMBLY                           $280.00



      NOTES:




                                              WWW.MAPLELEAFWHEELCHAIR.COM

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:10/5/2012
language:Unknown
pages:2