Quickie GP Swing-Away

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					                                                                  Quickie GP Swing-Away
                                                                       EIGPSA, Effective July, 2009
                        ORDERING INFORMATION PHONE: (02) 8858 9191 • FAX: (02) 9899 3084 • orders@sunrisemedical.com.au

                                                                             ACCOUNT INFORMATION

Account No: _______________________________________________________                                 Drop Ship/Ship To: ________________________________________________

Date: ______________________________________________________________                                Name: ___________________________________________________________

P.O. #: ____________________________________________________________                                Address: _________________________________________________________

Buyer: ____________________________________________________________                                 City: _________________________________________________________

Marked For: ________________________________________________________                                Post Code:_____________ Phone Number:_________________________

                         QUICKIE GP SWING AWAY                                                                                                    SEATING
                                                                                                    Cushion
      EIGPSA    K0005    Quickie GP Swing Away                                 $       2,587
                                                                                                          025CU1                         2"                                    $    118
                                   FRAMES                                                                 025CU2                         Omit Cushion                                NC
Frame Color                                                                                               025CU4                         Omit Sling                            -$    17
      025C2              Black                                                             NC                                                  BACKREST
      025C10             Black Opal                                                        NC       Back Type
      025C1              Blue                                                              NC             025BT1                         Folding Adjustable
      025C38             Blue Opal                                                         NC                 025BA1                     11"-14"                               $     95
      025C12             Blue Velvet                                                       NC                 025BA2                     12"-16"                               $     95
      025C36             Candy Blue                                                        NC                 025BA3                     14"-18"                               $     95
      025C35             Candy Red                                                         NC                 025BA4                     16"-20"                               $     95
                                                                                                                                                                      4,5
      025C39             Candy Turquoise                                                   NC                 025BT3                     Non-Folding Backrest
      025C6              Forest Green                                                      NC                 025BB1                     8"                                          NC
      025C4              Midnight Purple                                                   NC                 025BB2                     9"                                          NC
      025C37             Orange                                                            NC                 025BB3                     10"                                         NC
      025C5              Pearl Pink                                                        NC                 025BB4                     11"                                         NC
      025C40             Razzleberry                                                       NC                 025BB5                     12"                                         NC
      025C11             Toxic Green                                                       NC                 025BB6                     13"                                         NC
      025C8              Yellow                                                            NC                 025BB7                     14"                                         NC
Custom Color                                                                                                  025BB8                     15"                                         NC
      025C41             Berry Vibrations                                      $         353              025BB9                         16"                                         NC
      025C20             Graphite                                              $         353        Back Upholstery
      025C42             Stars and Stripes                                     $         353                  025BU1                     Standard                                    NC
      025C43             Mossy Oak Camouflage                                  $         353                  025BU8                     Adjustable 7                          $    185
Frame Width 1                                                                                                 025BU16                    Reinforced 4                          $     50
                               2
       025W3             12"                                                               NC             025BU14                        Omit Upholstery                       -$    17
                               2
       025W4             13"                                                               NC             025BT14                        Omit Backrest and Upholstery          -$    39
       025W5             14"                                                               NC             025BU34                        Jay Precision Back Med w/ Laterals $       512
       025W6             15"                                                               NC             025BU35                        Jay Precision Back Tall w/ Laterals    $   512
       025W7             16"                                                               NC             025BU41                        Jay Precision Back Med omit Laterals $     478
       025W8             17"                                                               NC             025BU42                        Jay Precision Back Tall omit Laterals $    478
       025W9             18"                                                               NC             025KE22                        Lateral Pad Symmetric Swing Away $         197
       025W10            19"                                                               NC             025KE20                        Lateral Pad Symmetric                  $   101
       025W11            20"                                                               NC             025KE19                        Lateral Pad Asymmetric                 $   101
Sling Depth                                                                                               025KE21                        Lateral Pad Asymmetric Swing Away $        197
       025SD5            12"                                                               NC       Backrest Options
      025SD6             13"                                                              NC                  025BT33                    Folding w/Integral Push Handles             NC
      025SD7             14"                                                              NC                  025A85                     Bolt-On Push Handles 3                $    123
      025SD8             15"                                                              NC                  025SR2                     Stroller Handle Regular 6             $    155
      025SD9             16"                                                              NC                  025SR3                     Stroller Handle Tall 6                $    155
      025SD10            17"                                                              NC
      025SD11            18"                                                              NC               FOOTNOTES:
                                                                                                       1
      025SD12            19"                                                   $          84               Seat width 1/2" narrower.
                                                                                                       2
      025SD13            20"                                                   $         168               Not available with adjustable upholstery.
                                                                                                       3
      025SD14            21"                                                   $         168               Not available with Xtender.
                                                                                                       4
      025SD33            22"                                                   $         168               Not available with adjustable upholstery.
                                                                                                       5
                                                                                                           Not available with push handles.
                                                                                                       6
                                                                                                           Not available with amputee axle plate or Xtender Power Assist.
                                                                                                       7
                                                                                                           Not available with fabric side guards.
                                                                                                       8
                                                                                                           Should additionally be billed as E0956.




                                   Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical Quickie GP Swing Away Order Form AU Rev A
                                                                                                   1 of 4
                               CASTERS
       025CW1          3" Micro                                            $          50
       025CW30         3" Light Up                                         $          73
       025CW3          4" Low Profile Polyurethane                         $          73
       025CW31         4" Light Up                                         $          73
       025CW5          5" Low Profile Polyurethane                                    NC
       025CW7          5" x 1.5" Semi-Pneumatic 17                         $          95
       025CW6          5" Soft Roll Semi-Pnuematic                         $          95
       025CW33         6" Pneumatic                                        $          84
       025CW34         6" Polyurethane                                                NC
       025CW35         6" x 1.5" Semi-Pneumatic 17                         $          95
       025CW21         8" Pneumatic                                        $          84
       025CW32         8" Polyurethane                                                NC
       025CW36         8" x 2" Pneumatic                                   $         162
       025CW37         8" x 2" Pneumatic w/Airless Inserts                 $         252
Caster Options 18
       025CS5          3/4" Longer Stem Bolt                                          NC
       025CS9          1-1/2" Longer Stem Bolt                                        NC
                       Caster Pin Locks 18                                 $         118
                                                           19, 20
      025CS4           Quick-Release Caster Stems                          $         226                                                AXLE AND WHEEL
                                                                                                                24
                               ARMREST                                                          Axle Plate
      025AA9           Height Adjustable Kids                              $         216                   025AL2                    Standard Adjustable                                NC
      025AM1            Desk Length (10")                                             NC                   025AL6                    Amputee Adjustable 22                     $       106
      025AM2            Full Length (14")                                             NC                   025AL13                   Double Slotted Adjustable                 $        87
                                                                                                         24
      025AA8           Height Adjustable Adult                             $         216        Axle
      025AM1            Desk Length (10")                                             NC                   025AX4                    Quick Release Steel                                NC
      025AM2            Full Length (14")                                             NC                   025AX5                    Quick Release Titanium 23                 $       302
      025AA17          Padded SA Kids (12"-14" Deep) 18                    $         209                   025AX11                   Quad Quick Release                        $       168
      025AA19          Padded SA Medium (15 Deep) 18                       $         209                   025AX16                   Quad Quick Release Titanium23             $       328
      025AA16          Padded SA Adult (16"-22" Deep) 18                   $         209
                              FOOTREST                                                                 FOOTNOTES:
                                                                                                   1
Hanger                                                                                                 Only available with kids angle adjustable, adult angle
       025H1           60o Swing Away                                                 NC               adjustable or 90 o footboard footplates.
       025H2           70o Swing Away                                                 NC           2
                                                                                                       Not available with extension tubes.
       025H3           70o V Swing Away 21                                            NC           3
                                                                                                       Only available with kids angle adjustable footplates.
       025H6           90o Swing Away 1, 2                                            NC           4
                                                                                                       Only available with composite and angle adjustable footplates.
       025H23          90o Elevating 2,3                                   $         311           5
                                                                                                       Only available with aluminum or adult adjustable footplates.
       025H24          Articulating 4                                      $         463           6
                                                                                                       Not available with 90 o hangers and elevating legrest.
       025H14          Elevating 5                                         $         252           7
                                                                                                       Not available with elevating legrests.
       025H32          Omit                                               -$          17           8
                                                                                                       Only available on 60 o, 70o, or 70oV hangers.
                                                                                                   9
Footplate                                                                                              Only available on 12" - 16" width frames.
       025F1           Composite w/Heel Loops 14"-20" 6,7                             NC          10
                                                                                                       Only available with elevating hangers.
       025F2           Foam w/Leg Strap 8                                  $          68          11
                                                                                                       Only available on the 60 o, 70o or 90o hangers.
       025F3           Adult Angle Adj. w/Heel Loops                       $         121          12
                                                                                                       Only available on the 60 o, 70o or 70oV hangers.
       025F4           Kids Angle Adj. w/Leg Strap 9                       $         121          13
                                                                                                       Not available with articulating legrest.
       025F5           Aluminum 10                                                    NC          14
                                                                                                       Only available with adult angle adjustable or kids angle
       025F62          90o Footboard 9,11                                             NC               adjustable footplates.
       025F48          Platform Flip Up w/Leg Strap 12                     $         166          15
                                                                                                       Not available with elevating and 90 o elevating legrests.
                                                                                                  16
       025F7           Omit Footplate & Extension Tube                    -$          17               Available with adult angle adj. and kids angle adjustable footplates.
                                                                                                  17
Extension Tube                                                                                         Only available in bottom fork hole.
                                                          7,13                                    18
       025E1           Short (See chart for lengths)                                   NC              Not available with Xtender Power Assist.
                                                                                                  19
       025E2           Medium (See chart for lengths)                                  NC              Not available with caster pin locks or with +3/4" or 1 1/2" fork stem bolt.
                                                                                                  20
       025E5           Long (See chart for lengths)                                    NC              Not available with 8" x 2" casters.
                                                                                                  21
       025E14          Regular ELR                                                     NC              NA with 12" wide. 13" wide only available with foam footplate. 14"-16" only available
       025E15          Long ELR                                                        NC              with foam or platfor flip-up footplate. 17"-20" available with composite, foam, adult
                                                                                                       angle adjustable and platform flip up.
       025E16          High Mount 14,15                                    $           84
                                                                                                  22
Footrest Accessories                                                                                   Not available with swing-away armrests.
       025A110         Toe Loop 16                                         $           39         23
                                                                                                       Only available with Quickie Performance wheel options.
                                                                                                  24
       025HL4          Omit Heel Loop                                                  NC              Not available with 8" x 2" casters or Xtender Power Assist.
                                                                                                  25
Impact Guard                                                                                           Should additionally be billed as E0951.
                                  8                                                               26
      025IG2           Neoprene                                            $           37              Should additionally be billed as K0038.




                               Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical Quickie GP Swing Away Order Form AU Rev A
                                                                                               2 of 4
Rear Anti-Tip                                                                                        Xtender Pwr Asst Tyre
      025AT1               Rear Anti-Tip                                        $           95
Rear Wheel                                                                                                      001XW1                    Xtender Pneumatic Tire                 NC
       025RW8              22" Mag 14                                                       NC       Xtender Pwr Asst Acc
       025RW9         22" Spoke 14                                                         NC               001XA1                        Xtndr Spare NiMH Power Pack       $   890
       025RW1         24" Mag                                                              NC        Backpack
       025RW2         24" Spoke                                                            NC               025A1                         Black Utility Backpack            $    62
       025RW11        26" Spoke 14                                              $         123               025A2                         Black/Charcoal Kids               $    62
Performance Wheel Rims14                                                                             Seat Pouch
       025RW15        24" Basketball                                            $         274               025A8                         Black                             $    49
       025RW16        26" Basketball                                            $         308        Crutch Holder13
       025RW17        24" Tennis                                                $         274               025A52                        Rigid Chair                       $    91
       025RW18        26" Tennis                                                $         308        Extra Leg Strap
                                                                  17
       025RW19             24" Heat-Treated Basketball                          $         364                                             Black                             $    34
       025RW20             26" Heat-Treated Basketball                          $         386        Miscellaneous
                                                                   23
       025RW23             24" Heat-Treated Tennis 32H                          $         364               025A82                        Caddy                             $    56
                                                                  23
       025RW21             24" Heat-Treated Tennis 36H                          $         364               025A83                        Tool Kit                          $    31
       025RW22             26" Heat-Treated Tennis 36H                          $         386        Positioning Belt
       025RW30             24" Spinergy 540 rim (Clinchers Only) 24             $       1,064                                             1.5" Auto Buckle                  $    67
                           Black Spokes                                                                   025A12                          2" Aircraft Buckle                $    95
                           Yellow Spokes                                                                  025A13                          2" Aircraft Buckle Padded         $   129
       025RR25             Omit Rear Wheel & Axle                              -$           62       Spoke Guard 12
                           (Intended size for set up _________)                                           025A23                          Black                             $   123
Rear Wheel Tire                                                                                           025A24                          Clear                             $   123
                                        18
       025RT1              Pneumatic                                                        NC       Touch-Up Paint
                                                          18,19
       025RT2              Pneumatic Airless Insert                             $         185                   025A27                    Frame                           $      28
       025RT3              Full Polyurethane 1,2                                           NC                                             Color: __________________________
       025RT4              Low Polyurethane 2,3,12                                         NC        Wheelchair Tray Table
       025RT8              Kevlar 2,3                                           $           81                                            Tray Table                        $   291
                                                        4,5
       025RT6              High-Pressure Clincher                               $           68       Side Guard
      025RT7               Latex Tubular 6,12                                   $         174                   025SG2                    Fabric Kids                       $    67
      025RT5               Turbo Tread 7,12                                                NC                   025SG1                    Fabric Regular                    $    67
Handrim12                                                                                                       025SG4                    Plastic Kids 11                   $   148
                                                                                                                                                               11
       025HR1            Aluminum Anodized                                                 NC                   025SG3                    Plastic Regular                   $   148
       025HR4            Plastic Coated                                         $         105
       025HR7            Omit Handrim                                          -$          22                                             TOTAL CHAIR PRICE
Projection Handrim
                 (Projections not available on plastic coated)                                              FOOTNOTES:
       025HR8            8 Oblique 8                                            $         284           1
                                                                                                            Not available on 26" wheels.
       025HR9            8 Vertical 8,9                                         $         284           2
                                                                                                            Not available with Quickie Performance wheel options.
       025HR10           12 Oblique 8                                           $         284           3
                                                                                                            Only available on 24" rims.
       025HR11           12 Vertical 8,9                                        $         284           4
                                                                                                            Only available on 24" and 26" spoke rims.
                                                                                                        5
Wheel Lock                                                                                                  Not available for heat treated rims.
                                                                                                        6
       025WL1            High Mount Push                                                    NC              Not available with heat-treated wheels.
                                                                                                        7
       025WL2            High Mount Pull                                                    NC              Only available with 24" or 26" heat treated wheel rims.
       025WL5            High Mount Scissor 10                                              NC          8
                                                                                                            Not available with 22" wheels.
                                                                                                        9
       025WL12           Do Not Mount                                                       NC              Not available with polyurethane, latex tubular, turbo or
       025WL10           Omit Wheel Lock                                                    NC              high-pressure clincher tires.
                                                                                                       10
Grade Aid                                                                                                   Not available with grade aids or extension handles.
                                        9                                                              11
       025GA1              Grade Aid                                            $         131               Not available with height adjustable armrests.
Extension Handle 12                                                                                    12
                                                                                                            Not available with Xtender Power Assist.
                                                                                                       13
       025EH1              6" Pair                                              $           49              Only available mounted to left side from rear
                                                                                                       14
                                ACCESSORIES                                                                 Not available with 8" x 2" casters or Xtender Power Assist.
                                                                                                       15
Xtender Power Assist                                                                                        Not available with swing-away armrests.
      001XT1            Xtender Power Assist 7                                  $       6,714          16
                                                                                                            Only available with Quickie Performance wheel options.
                                                                                                       17
Xtender Pwr Asst Handrim                                                                                    Available with turbo tread or latex tubular tires; no charge.
                                                                                                       18
                (You must choose one of the following torque options)                                       Not available with Quickie Performance wheel options.
                                                                                                       19
       001XH1              3x Torque Multiplier (Plastic Coated)                            NC              Not available on 26" wheels.
       001XH2              1.5x Torque Multiplier (Stainless Steel)                         NC




                                    Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical Quickie GP Swing Away Order Form AU Rev A
                                                                                                    3 of 4
                               JAY SEATING OPTIONS*
Select Cushion                   Select Back
    Jay Basic                        See Jay 3 order form
    Jay Soft Combi P
    Jay Xtreme
    Jay Xtreme S
    Jay Triad
    Jay Triad P
    Jay Care
    Jay Duo                       Indicate Backrest Width
    Jay Easy                      ______________________________
    Jay 2                         Indicate Exact Cushion Dimensions
    Jay 2 Recline                 (w" x d")_____________________
    Jay 2 Deep Contour

If a modification is necessary to achieve your cushion or backrest dimensions, do
you want customer service to notify you prior to placing this order?
    Please Choose
       Order modification and charge as per jay price lists
       Send Quote only when a modification has a charge
          Fax me #__________________________________
          Email me_________________________________________

* Please see Jay Price List for latest pricing information. Also, note that Jay cushions and
backs may ship from different distribution centers.




                                        Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical Quickie GP Swing Away Order Form AU Rev A
                                                                                                        4 of 4

				
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Description: Quickie GP Swing-Away