custom contoured seat order form - msrp - ki … version 10-13 custom contoured seat order form -...

www.icrehab.com version 10-13

Custom Contoured Seat Order Form - MSRP

Phone 800.676.5030

Fax 330.545.6389

Knob Release Kit (2-Point Mount)................................. #13007-15

One Inch Drop, U-Clamp Hardware Mounting Kit........... #2200-99

Velcro Hook & Loop Attachment (seat pan mount) ...... #13009-PM No Charge

Omit Mounting Hardware................................................ ($35.00)

Mounting Hardware-Options

Foam In Place Kits1/2 unit size..........................................................................#13011-FIP

1-full unit size.....................................................................#13011-FIP2

Soft Sunmate

Soft SunmateMedium Sunmate

Medium Sunmate

Qty:

Qty:

A- seat width

B- seat depth

C-

D-

E-

F-

G-

H-

I-

J-

1" Drop Hook Kit............................................................ #2211-99

2" Drop Hook Kit............................................................ #2213-99

3"Drop Hook Kit.............................................................. #2215-99

No Charge

No Charge

No Charge

Flush-Mount U-Clamp Hardware Mounting Kit...............

Cushion Separated from wood.............................#13007-22 $128.00

Full-Width Custom Contoured Seat................#13003-SA

Seat-Mount Information

Standard

Oversized Seat Upgrade..................................... #13007-05

Actual Seat width over 20" wide or 20" deep$67.00

Between-The-Rails-Custom Contoured Seat.....#13003-SA

Mounting Location Flush Mount 1" Drop 2" Drop 3" Drop

No ChargeSeat width will be 3'' narrower than chair width

Seat Contour-OptionsNote- Standard foam contour selection will pre-determine ABD/ADD and the Anti-thrust heights inside cushion. Custom dimensions can be made in-lieu or in-junction with the standard foam contour selections. Custom dimension selections will override standard contour selections.

Mild Foam Contours (1/2 inch build-ups)

Moderate Foam Contours (1 inch build-ups)

Aggressive Foam Contours (1-1/2 inch build-ups)

CUSTOM CONTOURED SEAT..............................#13003-SA...........$965.00

Track Mount Hardware............................... #13010-TM2

T-Nut for Attachment ................................................................ No Charge

Omit Track & T-nuts..................................................................... ($6.00)

Omit Wood ................................................................................. ($6.00)

A-

B-QUOTE ORDER PO#

Company Name:

Phone #

Client Name:

W/C Make:

W/C Model:

W/C Width: W/C Depth:

Contact Name:

Frame Color:

HCPC E2609

No Charge#2199-99

Knob Release Kit (4-Point Mount).............................. #13010-19 Standard

must be ordered with Back and 2-point kit w/seat-to-back-brackets

No Charge

$154.00

$209.00

No Charge

NEW STANDARD FEATURES! Includes: 4 -Point knob release mounting hardware, premium foam and Upholstery upgrade

Standard

Seating Order Form For Ki Mobility Bases

WC Base to be drop - shipped for seating installation?NO

YES

Skip to Page - 5 for Back Selection

Leg-Length discrepancy (Left or Right).............. #13005-LLD.........$67.00

Pelvic Obliquity Upgrade.....................#13005-OB.................No Charge

Wedge Upgrade.................................... #13008-WS...............No Charge

(choose multiple options)

Seat Rail Cut Outs (Full width drop in style seat)....#13007-15..... No Charge

www.icrehab.comversion 10-13

I-Cut Seat ( For x-brace and hardware clearance).............#13007-13.......$84.00

Anti-Thrust.............(Included in price, use for dimensions of anti-Thrust)

A-

B-

A-

B-

C-

D-

E-

A-

B-

A-

B-

Seat Options Sheet

Notched Seat Upgrade (Growth Tail).......#13007-10...............$40.00

A-

B-

C-

F-

D-

E-

C-

D-

E-

F-

G-

H-

C-

D-

E-

A-

B-

C-

D-

E-

F-

A-

B-

C-

D-

Seat Notes:


1/2" Medium Polyurethane Foam .......... #13040-04 $15.001" Soft Polyurethane Foam.................... #13040-03 $15.00

1/2" Soft Polyurethane Foam................. #13040-02 $7.00

1" Medium Polyurethane Foam.............. #13040-05 $23.00

1/4" Soft Polyurethane Foam................. #13040-01 $5.00

(Mid-Layer Foam)

1/2" Soft Visco Elastic Foam ........................ #13040-08 $37.00

1" Soft Visco Elastic Foam............................ #13040-10 $73.00

1/2" Super Soft Visco Elastic Foam.............. #13040-06 $37.00

1" Super Soft Visco Elastic Foam ................ #13040-07 $73.00

1/2" Soft SunMate Foam........................ #13040-11 $49.00

1" Soft SunMate Foam............................ #13040-12 $97.00

1/2" Medium SunMate Foam.................. #13040-13 $49.00

1" Medium SunMate Foam..................... #13040-14 $97.00

Poly FoamsVisco Elastic

SunMate Brand Foam

1/2" Neoprene Foam .................................... #13040-15 $27.00

Neoprene Foam

1/2" Soft SunMate Foam ................... #13050-10 $49.00

1" Soft SunMate Foam ...................... #13050-11 $97.00

1/2" Medium SunMate Foam.............. #13050-12 $49.00

1" Medium SunMate Foam................. #13050-13 $97.00

1/2" Poly-Gel (Cubed) ................................. #13050-16 $320.001/2" Poly-Gel (Flat) ...................................... #13050-15 $320.00

1/2" Poly-Gel (Cubed) > 20" width or ht....... #13050-18 $402.001/2" Poly-Gel (Flat) > 20" width or ht. ......... #13050-17 $402.00

1/2" Poly-Gel Inlay (Cubed) ........................ #13050-20 $122.00Top Middle Bottom

1/2" Poly-Gel Inlay (Flat).............................. #13050-19 $122.00

Top Middle Bottom

SunMate Brand Foam

Polymer GelOverlay-full sheet

Inlay half-sheet

1/2" Medium Polyurethane Foam........ #13050-04 $15.00

(Top-Layer Foam)

1/2" Soft Visco Elastic Foam ........................ #13050-08 $37.00

1" Soft Visco Elastic Foam .......................

1/2" Super Soft Visco Elastic Foam.............. #13050-06 $37.00

1" Super Soft Visco Elastic Foam................. #13050-07 $73.001" Soft Polyurethane Foam ................ #13050-03 $15.00

1/2" Soft Polyurethane Foam ............. #13050-02 $7.00

1" Medium Polyurethane Foam...........

1/4" Soft Polyurethane Foam.............. #13050-01 $5.00Poly Foams Visco Elastic

1/2" Neoprene Foam........................... #13050-14 $27.00

Neoprene Foam

Seat Foam Options & Upgrades

(Base-Layer Foam)

1/2" Medium Polyurethane Foam............ #13030-07 $15.001" Soft Polyurethane Foam..................... #13030-06 $15.00

1/2" Soft Polyurethane Foam.................. #13030-05 $7.00

1" Medium Polyurethane Foam............... #13030-08 $23.00

1/2" Soft Visco Elastic Foam......................... #13030-11 $37.00

1" Soft Visco Elastic Foam............................ #13030-12 $73.00

1/2" Super Soft Visco Elastic Foam ............. #13030-09 $37.00

1" Super Soft Visco Elastic Foam.................. #13030-10 $73.00

1/2" Soft SunMate Foam......................... #13030-13 $49.00

1" Soft SunMate Foam............................ #13030-14 $97.00

1/2" Medium SunMate Foam.................. #13030-15 $49.00

1" Medium SunMate Foam..................... #13030-16 $97.00


SunMate Brand Foam

1.5" Etha-Foam...................................... #13030-03 $37.00

1" Etha-Foam ........................................ #13030-02 $25.00

1/2" Etha-Foam ..................................... StandardEtha-Foam (high density)

1/2" Neoprene Foam.................................... #13030-04 $27.00

Neoprene Foam

Foam Notes:

2 3/4" Single Chamber Cushion .................. #13060-V1 $320.002 3/4" Dual Chamber Cushion..................... #13060-V2 $320.00

VARILITE Air-Foam Floatation Insert

$23.00#13050-05 Standard

version 10-13

www.icrehab.com

Seat Upholstery Options

Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Air-mesh Black-12 Neoprene Black-13Neoprene Velcro-Sensitive Black-14Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18

Select ONE Fabric Style For Contact Surface

Select ONE Fabric Style For Non-Contact Surface

Step-ONE

Step-TWO

Incontinent Inner-Liner Cover.............#13008-IC..........$122.00

Removable / Stretchy Slip Cover.......#13011-NC..........$150.00

Dual Slip covers.................................#13011-NC2........$300.00

Slip Covers / Liner's

Dartex (fabric Side) Black-10

Dartex Reversed (Smooth) Black-11

Air-mesh Black-12



Choose Contact Surface Choose Non-Contact Surface

Upholstery Notes:

Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18

Deep Violet Vinyl-20Blue Sparkle Vinyl-21Gold Sparkle Vinyl-22Burgundy Sparkle Vinyl-23Hot Pink Sparkle Vinyl-24Fuschia Sparkle Vinyl-25Silver Sparkle Vinyl-26Charcoal Sparkle Vinyl-27Green Sparkle Vinyl-28Cascade Sparkle Vinyl-29

Dove Vinyl-40Graymist Vinyl-41Blue Vinyl-42Passion Purple Vinyl-43Blueberry Vinyl-44Butterscotch Vinyl-45Red Swirl Vinyl-46

Orange Vinyl-48Hot Pink Vinyl-49Sun Yellow Vinyl-50CrocusVinyl-51Sky Blue Vinyl-52Carbon Vinyl-53Greystone Vinyl-54Fern Vinyl-55Crocus Vinyl-56

Space Blue Vinyl-47

Colored Vinyls

http://www.icrehab.com/files/Section%2012-Upholstery_Colors.pdf

To view upholstery Colors, please click link below

Full-Width Custom Contoured Back.......................#13009-SBA..... No charge

Between-The-Rails Custom Contoured Back....#13009-SBA.... Standardback width will be 3" narrower than chair width

Back-Mount Information

Track Mount Hardware............................... #13010-TM2 ....... Standard

T-Nut for Attachment .................................................................... No charge

Omit Track & T-nuts............................................................................($6.00)..

Oversized Back Upgrade........................................ #13010-05...................$67.00..actual back width over 19" or height over 23"

J & L Hardware Mounting Kit..................................................... No Charge

Knob Release Kit (4-Point Mount)........................................ #13010-19................

Knob Release Kit (2-Point Mount)............................................. #13010-15..................

w / seat-to-back brackets

Zero Inch Drop, U-Clamp Hardware Mounting Kit.......................... #2199-99.................

One Inch Drop, U-Clamp Hardware Mounting Kit.......................... #2200-99................

Velcro Hook & Loop Attachment (back pan mount) ....................... #13009-PM..............

Omit Mounting Hardware............................................................................................

2-Hole "J"s4-Hole "J"s7-Hole "J"s9-Hole "J"s

7-Hole "L"s9-Hole "L"s

1-Hole "L"s2-Hole "L"s3-Hole "L"s

5-Hole "L"s

Mounting Hardware-Options

select one "J" and one "L" length below

Flush bracket 1" Offset 2" Offset 3" Offset

Standard

Quick Clamp Hardware.................................................................. #1212...................

#2300-99.............

Foam In Place Kits

1/2 unit size..............................................................................#13011-FIP.................$154.00

1 full unit size........................................................................#13011-FIP2...............$209.00

Soft Sunmate

Soft SunmateMedium Sunmate

Medium SunmateQty:

Qty:

A= Back Width

B= Lateral Height

Headrest Options

Universal T-Nut Pattern for Headrests........................... Standard

Special T-Nut Pattern (specify in back note section).... #13010-ST.............$12.00

Omit T-Nuts for Headrest...................................................................................

T-Nut Location (Headrest)

Custom Contoured Back Order Form -MSRP

CUSTOM CONTOURED BACK.........#13009-SBA..............$990.00

NEW STANDARD FEATURES! Includes: 4 -Point knob release mounting hardware, Premium foam, Embroidery and Upholstery upgrade

C= Lateral Depth

No Charge

No Charge

No Charge

No Charge

(35.00)

No Charge

Mild Foam Contours (1/2 inch build-ups)

Moderate Foam Contours (1 inch build-ups)

Aggressive Foam Contours (1-1/2 inch build-ups)

Choose foam options above or select below, lateral contour width will be determined by overall foam layers and chest width provided.

HCPC E2617


Adjustable Foam Lumbar support (built-in).......... #13010-LS.........

Rounded-Top Back upgrade.............. #13011-RT.................

Bi-Angular locking/hinged Back.............. #13010-BI...............$155.00

(choose multiple options)

T-Back upgrade........................ #13010-T.........................


Curved ABS Back upgrade.........#13010-C............$122.00

A-

B-

A-

B-

C-

D-

A-

B-

C-

A-

B-

Back Options Sheet

Curved Foam Modification............................................. (standard)

A-

B-

C-

Note: Standard curved foam option will have an outside contour height of 1" tapered for Pediatrics, and 1.5" tapered for adults

Note: Incompatible with curved ABS option.

Notes:

Note: The rounded top size will be determined by the width unless specified below

CC

I-Back upgrade................#13010-I......................

A-

B-

C-

D-

E-

(standard)

(standard)(standard)

(standard)


1/2" Medium Polyurethane Foam ............. #13040-04............$15.001" Soft Polyurethane Foam...................... #13040-03..............$15.00

1/2" Soft Polyurethane Foam.................... #13040-02............$7.00

1" Medium Polyurethane Foam................ #13040-05.............$23.00

1/4" Soft Polyurethane Foam..................... #13040-01............$5.00

(Mid-Layer Foam)

1/2" Soft Visco Elastic Foam ........................ #13040-08.......$37.00

1" Soft Visco Elastic Foam........................... #13040-10........$73.00

1/2" Super Soft Visco Elastic Foam................ #13040-06........$37.00

1" Super Soft Visco Elastic Foam ................. #13040-07........$73.00

1/2" Soft SunMate Foam......................... #13040-11............. $49.00

1" Soft SunMate Foam............................ #13040-12...............$97.00

1/2" Medium SunMate Foam................... #13040-13.............. $49.00

1" Medium SunMate Foam..................... #13040-14.............. $97.00


SunMate Brand Foam

1/2" Neoprene Foam ..................................... #13040-15.......$27.00

Neoprene Foam

1/2" Soft SunMate Foam .............................. #13050-10...... $49.00

1" Soft SunMate Foam ...................... #13050-11...... Standard1/2" Medium SunMate Foam......................... #13050-12...... $49.00

1" Medium SunMate Foam........................... #13050-13...... $97.001/2" Poly-Gel (Cubed) ............................... #13050-16.......... $320.001/2" Poly-Gel (Flat) ................................... #13050-15..........$320.00

1/2" Poly-Gel (Cubed) > 20" width or ht........#13050-18.........$402.001/2" Poly-Gel (Flat) > 20" width or ht. ......... #13050-17....... $402.00

1/2" Poly-Gel Inlay (Cubed) ....................... #13050-20........ $122.00Top Middle Bottom

1/2" Poly-Gel Inlay (Flat)............................. #13050-19........ $122.00Top Middle Bottom

SunMate Brand Foam

Polymer GelOverlay-full sheet

Inlay half-sheet

1/2" Medium Polyurethane Foam................ #13050-04...........$15.00

(Top-Layer Foam)

1/2" Soft Visco Elastic Foam ....................... #13050-08..... $37.00

1" Soft Visco Elastic Foam ........................... #13050-09..... $73.00

1/2" Super Soft Visco Elastic Foam.............. #13050-06..... $37.00

1" Super Soft Visco Elastic Foam................. #13050-07..... $73.001" Soft Polyurethane Foam ......................... #13050-03......... $15.00

1/2" Soft Polyurethane Foam .................... #13050-02.......... $7.00

1" Medium Polyurethane Foam..................

1/4" Soft Polyurethane Foam..................... #13050-01.......... $5.00Poly Foams Visco Elastic

1/2" Neoprene Foam.................................. #13050-14......... $27.00

Neoprene Foam

Back Foam Options & Upgrades

(Base-Layer Foam)

1/2" Medium Polyurethane Foam........... #13030-07.............. $15.001" Soft Polyurethane Foam...................... #13030-06.............. $15.00

1/2" Soft Polyurethane Foam.................. #13030-05...............$7.00

1" Medium Polyurethane Foam............... #13030-08............. $23.00

1/2" Soft Visco Elastic Foam....................... #13030-11..........$37.00

1" Soft Visco Elastic Foam............................ #13030-12.........$73.00

1/2" Super Soft Visco Elastic Foam ............ #13030-09..........$37.00

1" Super Soft Visco Elastic Foam................. #13030-10.........$73.00

1/2" Soft SunMate Foam............................ #13030-13.......... $49.00

1" Soft SunMate Foam............................... #13030-14............$97.00

1/2" Medium SunMate Foam..................... #13030-15.......... $49.00

1" Medium SunMate Foam........................ #13030-16........... $97.00


SunMate Brand Foam

1.5" Etha-Foam....................................... #13030-03.............. $37.001" Etha-Foam .......................................... #13030-02............. $25.00

1/2" Etha-Foam ....................................... #13030-01............ $15.00Etha-Foam (high density)

1/2" Neoprene Foam..................................#13030-04............$27.00

Neoprene Foam

NOTES:

#13050-05........ $23.00

version 10-13

www.icrehab.com

Back Upholstery Options

Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Air-mesh Black-12 Neoprene Black-13Neoprene Velcro-Sensitive Black-14Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18

Select ONE Fabric Style For Contact Surface

Select ONE Fabric Style For Non-Contact Surface

Step-ONE

Step-TWO

Upholstery Notes:

Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18

Deep Violet Vinyl-20Blue Sparkle Vinyl-21Gold Sparkle Vinyl-22Burgundy Sparkle Vinyl-23Hot Pink Sparkle Vinyl-24Fuschia Sparkle Vinyl-25Silver Sparkle Vinyl-26Charcoal Sparkle Vinyl-27Green Sparkle Vinyl-28Cascade Sparkle Vinyl-29

Dove Vinyl-40Graymist Vinyl-41Blue Vinyl-42Passion Purple Vinyl-43Blueberry Vinyl-44Butterscotch Vinyl-45Red Swirl Vinyl-46

Orange Vinyl-48Hot Pink Vinyl-49Sun Yellow Vinyl-50CrocusVinyl-51Sky Blue Vinyl-52Carbon Vinyl-53Greystone Vinyl-54Fern Vinyl-55Crocus Vinyl-56

Space Blue Vinyl-47

Colored Vinyls

http://www.icrehab.com/files/Section%2012-Upholstery_Colors.pdf

To view upholstery Colors, please click link below

Incontinent Inner-Liner Cover.............#13008-IC..........$122.00

Removable / Stretchy Slip Cover.......#13011-NC..........$150.00

Embroidery................#Uph-15......... StandardScript Lettering Block Lettering

TEXT:

THREAD COLOR:

Dual Slip covers.................................#13011-NC2........$300.00

Thread will be color matched to "Colored Fabric" if selected

Slip Covers / Liner's



Air-mesh Black-12



Choose Contact Surface Choose Non-Contact Surface

Slim-fit Brackets Lever Release Hip Support Brackets

5x7 (Large)

(E0956) $78.00

(E0956 / E1028) $488.00

(Pair)(Pair)

version 10-13

www.icrehab.com

Hip Support Options

Note: All Lateral Pads Come Standard with 1/2'' Of neoprene Foam and STD Dartex upholstery unless stated otherwise.

Foam Upgrade Options #0099 $20.00

Choose Hardware...............................

2" Offset

1" Offset

0" Offset

5" Bracket

6" Bracket

Choose Pad Style........................

(1/4" ABS) Base Support (1/2" Wood) Base Support

Choose Size........................................

4x6 (Medium)

3x5 (Small)

Choose Foams....................

1/2" Medium Polyurethane Foam 1" Soft Polyurethane Foam

1/2" Soft Polyurethane Foam

1" Medium Polyurethane Foam


1/2" Soft Visco Elastic Foam

1" Soft Visco Elastic Foam

1/2" Super Soft Visco Elastic Foam

1" Super Soft Visco Elastic Foam

1/2" Soft SunMate Foam

1" Soft SunMate Foam

1/2" Medium SunMate Foam

1" Medium SunMate Foam

Poly Foams

Visco Elastic

SunMate Brand Foam

1/2" Neoprene Foam ..........................(standard)

Choose Upholstery...............

Match Upholstery of Seat ..........................(standard)

Included in back upholstery price

Lateral Upholstery Notes:

Other (explain below)

STD Dartex

Reversed Dartex

Add on top of standard foam...............(standard option)

Replace standard foam..................choose multiple options below

Rectangular Pads (wood only)

A-

B-A-

B-

C-

D-

Contoured Pads (wood only)

$118.00

$118.00

$118.00

$160.00 $160.00


Removable Knee Adductor (E0956/E1028)

(One) 7/8" Frame-Mount Bracket........................#11067-E...................$329.00.

(Pair) 7/8" Frame-Mount Brackets......................#11067-2...................$658.00.

(One) 1" Frame-Mount Bracket...........................#11068-E...................$329.00.

(Pair) 1" Frame-Mount Brackets........................#11068-2...................$658.00..

Hanger-Mount Knee Adductors(Polymer-Gel pad(s) and hardware included)

Fixed Knee Adductor (E0956)

"Knee Button" Style Adductors (E0956)

(Pair) "Knee Button" Adductors Brackets.............#11066................$145.00..

Small Pad (A-3") (B-4") (C-3") (D-2.5") ..................................#11059-10.........$259.00

Medium Pad (A-4") (B-5") (C-3") (D-3.5") ................................#11059-11........$259.00

Knee Abductor "Econo-Removable" (E0957 / E1028)

(Pad and hardware included)

Large Pad (A-5") (B-6") (C-3") (D-4.5") ...................................#11059-12....... . $259.00

Custom Size Pad (specify dimensions below)....................................#11059-15.........$304.00.

Abductor Pad / Options / Upgrades

SunMate foam / dartex uph.................... (no charge)

Special foam / upholstery............... #0099................ $30.00

Small Pad (A-3") (B-4") (C-3") (D-2.5")..........................#11060-10........... $362.00Medium Pad (A-4") (B-5") (C-3") (D-3.5".........................#11060-11...........) $362.00

Flip-Down Knee Abductor (E0957 / E1028)

(Pad and hardware included)

Large Pad (A-5") (B-6") (C-3") (D-4.5")............................#11060-12.......... $362.00Custom Size Pad (specify dimensions below) ...........................#11060-15......... $410.00

A-

B-

C-

D-

A-

B-

C-

D-

Note:SunMate foam / reversed dartex uph......(no charge)

Knee Abductor Options

(One) 7/8" Frame-Mount Bracket........................#11064-E...................$301.00.

(Pair) 7/8" Frame-Mount Brackets......................#11064-2...................$602.00.

(One) 1" Frame-Mount Bracket...........................#11065-E...................$301.00.

(Pair) 1" Frame-Mount Brackets........................#11065-2...................$602.00..

Match Seat Surface / Sunmate Foam.....(standard)

Lower Extremity Options

Velcro Release (Pair) Adjustable mount

(E0951)

Large (10"-12" Circumference)......................#110451-L...................$156.00

Ankle Cuffs

Medium (8"-10"Circumference)......................#110451-M..................$156.00Small (6"-8" Circumference)..........................#110451-S...................$156.00

Side Release (Pair) Adjustable mount

Large (10"-12" Circumference)......................#110452-L...................$156.00

Medium (8"-10" Circumference).....................#110452-M..................$156.00Small (6"-8" Circumference)..........................#110452-S...................$156.00

Padded Velcro Release (Pair)

(E0951)

Adult...........................#11003...................$60.00

Toe / Ankle Straps

Youth..........................#11002...................$58.00Child...........................#11001...................$54.00

Non-Padded Velcro Release (Pair)

Xtra Large...................#11003-XL.............$60.00

Adult...........................#11006...................$31.00

Youth..........................#11005...................$31.00Child...........................#11004...................$31.00

Xtra Large...................#11006-XL.............$31.00

Heel Loops (Pair)

(E0951)

Adult...........................#11012...................$26.00

Heel Supports

Child...........................#11011...................$26.00

Heel Cups (Pair)

Adjustable...................#11012-1................$26.00

Non-padded...................#11013-X...............$126.00Padded..........................#11013...................$167.00

2-Piece Footbuckets

7" Padded..........................#11036-01X...................$430.00

6" Padded...........................#11036-00X...................$402.005" Padded...........................#11035-90X...................$402.00

(K0108)Footbuckets

10" Padded........................#11036-04X...................$450.00

9" Padded...........................#11036-03X...................$450.008" Padded..........................#11036-02X...................$430.00

1-Piece Footbuckets

16.5" Padded..........................#11037-02X...................$450.00

14.5" Padded...........................#11037-01X...................$400.0012.5" Padded...........................#11037-00X...................$400.00

Mounting Hardware

Omit Harware

1" Clamp mount brackets.................$75.007/8" Clamp mount brackets...............$75.00

Calf Panel Straps Hyper-Cel Dbl Velcro

20"-22" Frame..........................#11048-12...................$70.00

16"-19" Frame...........................#11048-11...................$70.0012"-15" Frame...........................#11048-10..................$70.00

Calf / Leg Supports

Calf Panel Straps Hyper-Cel Dbl Side Release

20"-22" Frame..........................#11048-22...................$70.00

16"-19" Frame...........................#11048-21...................$70.0012"-15" Frame...........................#11048-20..................$70.00

(K0108)


2-Point Seatbelts (Padded)

Pediatric 1" Side Release, 42" Length, STD pull (BA).......#11022-A2...........$57.00Pediatric 1" Pushbutton, 42" Length, STD pull (BA)..........#11022-D2...........$58.00

Positioning Seat Belts (E0978)

Youth 1.5" Side Release, 60" Length, STD pull (BA).........#11022-B4...........$60.00Youth 1.5" Pushbutton, 60" Length, STD pull (BA)............#11022-E4...........$69.00

Adult 2" Side Release, 80" Length, STD pull (BA).............#11022-C6...........$69.00Adult 2" Pushbutton, 80" Length, STD pull (BA).................#11022-F6...........$84.00

4-Point Seatbelts (Padded)

Youth 1.5" Pushbutton, 60" Length, STD pull (BA)............#11022-E22...........$96.00Pediatric 1" Pushbutton, 42" Length, STD pull (BA)..........#11022-A20...........$77.00

Adult 2" Pushbutton, 80" Length, STD pull (BA).................#11022-F24..........$88.00

version 10-13

Headrest & Hardware Options

(Flip-Down) Headrest (Detachable) "Sway" Headrests(Offset) Multi-Axis

Headrests / Removable

(Fixed) "Sway" Headrests (Straight) Multi-Axis

Headrest / RemovableFlip-Down Headrest

$385.00

Offset Multi-Axis Headrest

$213.00

Straight Multi-Axis Headrest

$213.00 4" Offset / 1'' Ball$222.00

2" Offset / 1'' Ball$222.00

4" Offset / 1'' Ball$192.00

2" Offset / 1'' Ball$192.00

Large Comfort Max (11'')

$137.00Small Tri-panel (4Hx4L)

$298.00Large Tri-panel (5Hx5L)

$298.00

Large Molded 11''

$119.00

Small Molded 9''

$119.00

Molded Head/Neck

$119.00 $119.00Molded Contoured

(E0955)...........................Molded Headrest Pads

Choose Harware (E1028)..........................................

Premium Headrest Pads

Comfort Max Tri-Panel

Small Comfort Max (9'') $137.00

STD Dartex

Reversed Dartex

Air Mesh with STD Dartex on non-contact

Air Mesh with Reversed Dartex on non-contactContact Surface Non-Contact Surface

STD Dartex

Reversed Dartex

STD Dartex

Reversed Dartex

Naugahyde

Colored Naugayde (Same Color as Back)

Air Mesh with Reversed Dartex on non-contact

Air Mesh with STD Dartex on non-contact

(E0955)...........................

www.icrehab.com

Slim-fit Brackets Lift and Swing Brackets Quick Release/ Adjustable Laterals

5x7 (Large)

(E0956) $78.00

(E0956 / E1028) $489.00 (E0956 / E1028)

$489.00

(Pair)(Pair)(Pair)

version 10-13

www.icrehab.com

Trunk Support Options

Custom Laterals X $160.00

Note: All Lateral Pads Come Standard with 1/2'' Of neoprene Foam and STD Dartex upholstery unless stated otherwise.

Foam Upgrade Options #0099 $20.00

Choose Hardware...............................

2" Offset

1" Offset

0" Offset

1" Offset

0" Offset5" Bracket

6" Bracket

Choose Pad Style........................

ABS Curved Laterals ABS Flat Laterals Wood Oval Laterals

Choose Pad Size........................................

4x6 (Medium)

3x5 (Small)

Choose Foams....................

1/2" Medium Polyurethane Foam 1" Soft Polyurethane Foam


1" Medium Polyurethane Foam


1/2" Soft Visco Elastic Foam

1" Soft Visco Elastic Foam

1/2" Super Soft Visco Elastic Foam

1" Super Soft Visco Elastic Foam

1/2" Soft SunMate Foam

1" Soft SunMate Foam

1/2" Medium SunMate Foam

1" Medium SunMate Foam

Poly Foams

Visco Elastic

SunMate Brand Foam

1/2" Neoprene Foam ......................... Standard

Choose Upholstery...............

Match Upholstery of Back ................ Standard

Included in back upholstery price

Lateral Notes:

Other (Specify below)

STD Dartex

Reversed Dartex

Add on top of standard foam...............(standard option)

Replace standard foam..................choose multiple options below

$118.00 $118.00 $118.00

Note: Custom laterals larger than 5x7 will be made with wood only

Ht. x Depth

www.icrehab.com

Slim-Fit Style (E0960)

Butterfly Style (E0960)

X-Small (A-11") (B-2") (C-5.5")

Small (A-11.5") (B-2.25") (C-6")

Medium (A-13.5") (B-4.5") (C-6.25")

Large (A-14.5") (B-4.5") (C-7.75")

X-Small (A-14") (B-4") (C-4")

Small (A-17") (B-5") (C-5")

Medium (A-20") (B-6") (C-6")

Large (A-22") (B-7") (C-7")

X-Small (A-14") (B-4") (C-4")

Small (A-17") (B-5") (C-5")

Medium (A-20") (B-6") (C-6")

Large (A-22") (B-7") (C-7")

X-Small (A-12") (B-7.5")

Small (A-14") (B-8")

Medium (A-16.5") (B-8.5")

Large (A-19") (B-9")

Standard-Fit Style (E0960)

H-2 Style (E0960)

Hyper-cel Style......$116.00

Zippered Style........$125.00

Vinyl Face Style......$134.00

No-Stretch Style......$138.00

X-Small Harness

Small Harness

Medium Harness

Large Harness

X-Small Harness

Small Harness

Medium Harness

Large Harness

X-Small Harness

Small Harness

Medium Harness

Large Harness

X-Small Harness

Small Harness

Medium Harness

Large Harness

version 10-13

Chest Harness Options

Hyper-cel Style........$116.00

Vinyl Face Style........$134.00

Hyper-cel Styl........$116.00

Vinyl Face Style.....$134.00

No-Stretch Style.....$138.00

Hyper-cel Stye.........$116.00

Vinyl Face Style........$134.00

No-Stretch Style........$138.00

Chest Harness Strap Risers/Guides (K0108)

1'' Webbing Strap Risers #11041-01

$46.00

2'' Webbing Strap Risers #11041-02

Choose Size Choose Style Extras

custom contoured seat order form - msrp - ki … version 10-13 custom contoured seat order form -...

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