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Page 1 of 2 INFINFB3796/RevC/10NOV2017 Home Decor, NM-435M & NM-435LT, Quick Ship Order Form Pride Mobility Products Corp. 182 Susquehanna Ave., Exeter, PA 18643 Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected] Account Number: ___________ Date: ________________ Provider Name: __________________________________ Contact: ________________________________________ Phone: ___________________ Fax: _________________ Email:__________________________________________ PO Number:_____________________________________ Marked for: _____________________________________ Ship to Address: _________________________________ City: _____________________ State: ______ Zip: ______ Select a Bishop Fabric Color Dove Part: FABBDV Navy Part: FABBNV Dark Chocolate Part: FABBDC Burgundy Part: FABBBG Select a chair for a single chair order 375 lbs weight capacity. NM-435M ..........................................................................$1,399 5'4" to 6' height range with 20" seat width Part: NM435MMODEL This is not a medical device and is not intended to assist, treat, diagnose or alleviate any medical condition or disability. NM-435LT .........................................................................$1,499 6'1" to 6'8" height range with 22" seat width Part: NM435LTMODEL This is not a medical device and is not intended to assist, treat, diagnose or alleviate any medical condition or disability. See page 2 for multiple chair orders. Full Recline Capable TV Recline Capable Protective Pad .................................$30 Part: ACCASMB2514 Head Pillow ......................................$50 Dove part: UPSHDPL1464 Navy part: UPSHDPL1465 Dark Chocolate part: UPSHDPL1466 Burgundy part: UPSHDPL1467 Lumbar Pillow..................................$50 Dove part: UPSBOLT1595 Navy part: UPSBOLT1596 Dark Chocolate part: UPSBOLT1597 Burgundy part: UPSBOLT1598 Wireless Remote .............................$89 Part: ELE165917 Residential ......................$39.90 ea. Cleaning Kits Part: ACCASMB2479 Select upgrades and accessories for a single chair order This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power lift recliner. Please contact technical service for accurate parts ordering. Thank you for choosing Pride ® Mobility Products! Introduction

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Page 1: Home Decor, NM435 Order Form - Pride Mobility® | Live ......INFINF36RevC10NO201 Page 1 of 2 Home Decor, NM-435M & NM-435LT, Quick Ship Order Form Pride Mobility Products Corp. 182

Page 1 of 2INFINFB3796/RevC/10NOV2017

Home Decor, NM-435M & NM-435LT, Quick Ship Order Form

Pride Mobility Products Corp.182 Susquehanna Ave., Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

Select a Bishop Fabric ColorDovePart: FABBDV

NavyPart: FABBNV

Dark ChocolatePart: FABBDC

BurgundyPart: FABBBG

Select a chair for a single chair order 375 lbs weight capacity.

NM-435M ..........................................................................$1,3995'4" to 6' height range with 20" seat widthPart: NM435MMODELThis is not a medical device and is not intended to assist, treat, diagnose or alleviate any medical condition or disability.

NM-435LT .........................................................................$1,4996'1" to 6'8" height range with 22" seat widthPart: NM435LTMODELThis is not a medical device and is not intended to assist, treat, diagnose or alleviate any medical condition or disability.

See page 2 for multiple chair orders.

Full Recline Capable

TV Recline Capable

Protective Pad .................................$30Part: ACCASMB2514

Head Pillow ......................................$50Dove part: UPSHDPL1464Navy part: UPSHDPL1465Dark Chocolate part: UPSHDPL1466Burgundy part: UPSHDPL1467

Lumbar Pillow ..................................$50Dove part: UPSBOLT1595Navy part: UPSBOLT1596Dark Chocolate part: UPSBOLT1597Burgundy part: UPSBOLT1598

Wireless Remote .............................$89Part: ELE165917

Residential ......................$39.90 ea.Cleaning KitsPart: ACCASMB2479

Select upgrades and accessories for a single chair order

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power lift recliner. Please contact technical service for accurate parts ordering.

Thank you for choosing Pride® Mobility Products!

Introduction

https://get.adobe.com/reader/
Page 2: Home Decor, NM435 Order Form - Pride Mobility® | Live ......INFINF36RevC10NO201 Page 1 of 2 Home Decor, NM-435M & NM-435LT, Quick Ship Order Form Pride Mobility Products Corp. 182

Page 2 of 2INFINFB3796/RevC/10NOV2017

Account Number: ___________ Date: ________________ Marked for: _____________________________________

Multiple Unit OrderEnter a quantity below and then place check marks in the field with the desired option.

NM-435M ($1,399)

NM-435LT ($1,499) Dove Residential

Cleaning KitProtective

PadBurgundyNavy HeadPillow

LumbarPillow

DarkChocolate

Wireless Remote

© 2017 Pride Mobility Products Corp. All rights reserved.

youtube.com/pridemobility

facebook.com/PrideMobilityProductsCorp

twitter.com/pridemobility

instagram.com/PrideMobilityProducts

LIFT

Pride Mobility Products Corp.182 Susquehanna Ave., Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected]

QTY Upgrades and AccessoriesBishop Fabrics

https://www.youtube.com/user/PrideMobility
https://www.facebook.com/PrideMobilityProductsCorp
https://www.twitter.com/PrideMobility
https://www.instagram.com/pridemobilityproducts/

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