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ACCOUNT # / SHIP TO: NAME:

DATE: ADDRESS:

P.O. # CITY/ STATE:

BUYER: ZIP CODE:

MARKED FOR: PHONE #:

BASE MODEL CASTER FORK Please see matrix on page 3 for additional information□ 184WM32 K0005 Quickie 2 (EIQ2N) $2,050.00 □ 184CF46 Multi Position Fork-Short NC

□ 184CF47 Multi Position Fork- Tall NCREAR FRAME TYPE 265 lbs. Weight Capacity □ 184CF62 3" Fork NC

□ 184RS1 Rear Side Frame Straight NC □ 184CF12 5 1/4" Fork NC□ 184RS2 Rear Side Frame Rounded NC □ 184CF17 6 " Fork NC

□ 184CF23 7" Fork NCHEAVY DUTY PACKAGE 350 lbs. weight capacityNA w/ small frame, tension adj upholstery. Includes reinforced back upholstery & stabilizer bar HANGERS Front mount available w/ aluminum angle adj footplates □ 184HV1 K0108 Heavy Duty (18"-22" w. only) $500.00 □ 184H85 60° Swing In/Out Hanger NC □ 184H86 70° Swing In/Out Hanger NCFRAME WIDTH □ 184H88 70° Hemi Swing In/Out Hanger NC

□ 184W5 14" NC □ 184H89 70° Swing In/Out Front Mount NC□ 184W6 15" NC □ 184H90 80° Swing In/Out Front Mount NC□ 184W7 16" NC □ 184H91 90° Swing In/Out Front Mount NC□ 184W8 17" NC

□ 184W9 18" NC FOOTPLATES□ 184W10 19" NC□ 184W11 E2201 20" $450.00 □ 184F1 Composite 13"-22" W NC□ 184W12 E2201 21" (Only Avail. With Heavy Duty) $450.00 □ 184F271 K0040 Composite Angle Adj. 16" - 22" W $150.00□ 184W13 E2201 22" (Only Avail. With Heavy Duty) $450.00 □ 184F3 K0040 Aluminum Angle Adj. 12"-22" W $185.00

SEAT DEPTH FOOTPLATE OPTIONS□ 184SD7 14" NC □ 184HL1 E0951 Heel Loop $30.00□ 184SD67 15" NC□ 184SD9 16" NC EXTENSIONS Required w/ extension tube mounted hangers

□ 184SD69 17" NC □ 184E1 Short NC□ 184SD70 18" NC □ 184E2 Medium NC□ 184SD71 19" $75.00 □ 184E5 Long NC□ 184SD13 E2203 20" $475.00 * Select lower leg length setting at least 2" shorter than FSH.

* Footrest Length Matrix found on page 3FRAME LENGTH

□ 184FL83 Small (12"-14") NC REAR SEAT HEIGHT (13" only w/ curved axle plate and rounded rear)

□ 184FL9 Regular (13"-16") NC □ 184RH11 13" NC 184RH26 17.5" NC□ 184FL18 Long (15"-18") NC □ 184RH12 13.5" NC 184RH20 18" NC□ 184FL25 X-Long (17"-20") (Steel Reinforced) NC □ 184RH13 14" NC 184RH27 18.5" NC□ 184FL17 Hemi (13"-16") NC □ 184RH14 14.5" NC 184RH21 19" NC□ 184FL24 Long Hemi (15"-18") NC □ 184RH15 15" NC 184RH37 19.5" NC□ 184FL29 X-Long Hemi (17"-20") (Steel Reinforced) NC □ 184RH16 15.5" NC 184RH22 20" NC

□ 184RH17 16" NC 184RH38 20.5" NCFRONT SEAT HEIGHT Please see matrix on page 3 for additional information □ 184RH18 16.5" NC 184RH23 21" NC

□ 184SH41 14" NC 184SH18 18" NC □ 184RH19 17" NC□ 184SH42 14.5" NC 184SH20 18.5" NC□ 184SH12 15" NC 184SH21 19" NC BACK HEIGHT□ 184SH13 15.5" NC 184SH23 19.5" NC □ 184B5 Medium (12"-15") NC□ 184SH14 16" NC 184SH24 20" NC □ 184B9 Tall (16"-19") NC□ 184SH15 16.5" NC 184SH26 20.5" NC□ 184SH16 17" NC 184SH27 21" NC BACK HEIGHT SETTING□ 184SH17 17.5" NC □ 184UX10 12" NC 184UX18 16" NC

□ 184UX12 13" NC 184UX20 17" NCCASTER WHEEL All 8" casters NA w/ 90° hangers and small frame □ 184UX14 14" NC 184UX22 18" NC

□ 184CW64 4" x 1.5" Aluminum Soft Roll $135.00 □ 184UX16 15" NC 184UX24 19" NC□ 184CW5 5" Low Profile Polyurethane NC□ 184CW65 5" x 1" Aluminum Polyurethane $100.00 BACK TYPE□ 184CW7 5" x 1.5" Semi-Pneumatic $85.00 □ 184BT10 Standard NC□ 184CW6 5" Soft Roll (Grey) $85.00□ 184CW66 5" x 1.5" Aluminum Soft Roll $145.00 BACK POST OPTIONS □ 184CW33 E2214 E2215 6" Pneumatic $75.00 □ 184BP1 Push Handle Straight NC□ 184CW34 6" Polyurethane NC □ 184BP3 Push Handle 8° $25.00□ 184CW35 6" x 1.5" Semi Pneumatic $85.00□ 184CW68 6" x 1.5" Aluminum Soft Roll $160.00 STABILIZER BAR Standard with heavy duty package

□ 184CW21 E2214 E2215 8" Pneumatic $75.00 □ 184SZ1 Stabilizer Bar $105.00□ 184CW39 8" x 1.5" Semi Pneumatic $85.00

ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2009, Sunrise Medical (US) LLC. Quickie 2 "Easy"- of 3 119128 Rev E

Heel loop or leg strap not included, See Footplate Options Section

Quickie 2EIQ2N "Easy" Short Order Form, Effective August 2013

The HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payor's coverage policy.

For a full list of available options and configurations see the standard Quickie 2 Order Form

Q2 Short "Easy", August 2013

BACKREST UPHOLSTERY WHEEL LOCK Additional no gos may exist depending on wheel size and position

□ 184BU1 Standard Upholstery NC □ 184WL1 High Mount Push NC□ 184BU8 Tension Adjustable Upholstery $175.00 □ 184WL2 High Mount Pull NC

NA w/ HD package

BACKREST OPTION only available with std upholstery and HD option EXTENSION HANDLE□ 184OD4 Reinforced Upholstery $50.00 □ 184EH7 E0961 Extension Handle (Pair) $60.00

JAY BACK OPTION AXLE□ 184JB01 Jay J3 Back (See J3 Back Order Form) Price List □ 184AX1 Quick Release Steel NC

MILITARY SERVICE PATCHES (OPTIONAL) GRADE AID NA w/ poly or Kik tires. NA w/ short frame.Only available on tension adjustable upholstery and J3 back □ 184GA1 E0974 Grade Aid $150.00

□ 184VU1 Marines Patch $90.00□ 184VU2 Army Patch $90.00 SEAT SLING□ 184VU3 Navy Patch $90.00 □ 184SL1 Standard Seat Sling NC□ 184VU4 Air Force Patch $90.00□ 184VU5 Purple Heart Patch $90.00 CUSHION□ 184VU8 Purple Heart with Marines Patch $145.00 □ 184CU1 E2601 2" Cushion $95.00□ 184VU9 Purple Heart with Army Patch $145.00□ 184VU10 Purple Heart with Navy Patch $145.00 JAY CUSHIONS (OPTIONAL)□ 184VU11 Purple Heart with Air Force Patch $145.00

AXLE PLATE Min RSH 13.5" Max 22"□ 184AL33 Standard Adjustable NC □□ 184AL5 Curved Adjustable $55.00

REAR WHEEL TYPE SIDE GUARD NA w/height adj. armsUltra lightweight wheels only available w/ aluminum anodized handrim Side guard interference with Padded SA arms at some heights may exist

□ 184RW3 20" Mag Wheel NC □ 184SG33 K0108 Plastic Standard (8.5" High) $125.00□ 184RW8 22" Mag Wheel NC □ 184SG29 K0108 Plastic Low (6.5" High) $125.00□ 184RW1 24" Mag Wheel NC□ 184RW90 20" Lite Spoke Wheel $200.00 ANTI-TIP□ 184RW91 22" Lite Spoke Wheel $200.00 □ 184AT1 E0971 Rear Anti-Tip 135.00$ □ 184RW92 24" Lite Spoke Wheel NC□ 184RW77 22" Ultra Lightweight Spoke Wheel $250.00 TRANSIT OPTION NA w/ padded swing away arms

□ 184RW78 24" Ultra Lightweight Spoke Wheel $250.00 □ 184TO1 Transit System $315.00□ 184RW28 22" Spinergy SPOX Black $695.00□ 184RW95 24" Spinergy SPOX Black $695.00 BACKPACK AND SEAT POUCH□ 184RW32 22" Spinergy LX Black $895.00 □ 184A1 Quickie Backpack Black $55.00□ 184RW98 24" Spinergy LX Black $895.00 □ 184A8 Quickie Seat Pouch Black $45.00

REAR WHEEL TIRE POSITIONING BELTS □ 184RT1 E2211 E2212 Pneumatic NC □ 184A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00□ 184RT2 E2211 E2213 Pneumatic Airless Insert $80.00 □ 184A117 E0978 Belt 2" Aircraft Buckle w/Clamps $110.00□ 184RT3 E2218 Full Poly NC □ 184A118 E0978 Belt 2" Aircraft Buckle Pad w/Clamp $120.00□ 184RT22 E2218 Kik® Mako Black (24" only) $95.00 □ 184A120 K0108 Positioning Belt Slide Clamps $50.00□ 184RT6 E2211 E2212 High-Pressure Clincher $95.00□ 184RT21 E2211 E2212 Schwalbe Marathon Plus Evolution $125.00 MISCELLANEOUS

□ 184A82 Caddy (NA w/ front mount hangers) $45.00HANDRIM Natural Fits are available in 22", 24", and 25" sizes □ 184A49 E2207 Crutch Holder $195.00

□ 184HR1 Aluminum Anodized NC □ 184A55 K0038 Extra Leg Strap Black $30.00□ 184HR4 Plastic Coated -NA on all rims $95.00 □ 184IG2 Impact Guard Neoprene $85.00□ 184HR22 Natural Fit - Standard Grip $375.00 □ 184A73 K0105 IV Holder $275.00□ 184HR23 Natural Fit - Super Grip $395.00 □ 184A145 E2208 O2 Holder (NA w/ transit option) $310.00

□ 184A83 Tool Kit $45.00ARMREST Not all armrests available with all on chair options or frame lengths □ 184A31 E0950 Tray Table $250.00Some limitations may exist with integral push handles, some RSHs and wheel sizes

□ 184AA18 E0973 Padded Swing-Away STD (9" to 13") $175.00 FRAME COLORSetting 9" 10" 11" 12" 13" □ 184C2 Black NC 184C4 Midnight Purple NC

Please Circle □ 184C10 Black Opal NC 184C5 Pearl Pink NC□ 184AA11 E0973 Single Post Hgt. Adj. Std $260.00 □ 184C38 Blue Opal NC 184C103 Rootbeer NC□ 184AA29 E0973 Single Post Hgt. Adj. Low $260.00 □ 184C36 Candy Blue NC 184C114 Sparkle Silver NC□ 184AA6 E0973 Flip Back Height Adj (Classic) $275.00 □ 184C14 Candy Purple NC 184C113 Titanium Paint NC□ 184AA65 E0973 Flip Back Height Adj (LITE) $275.00 □ 184C35 Candy Red NC 184C11 Toxic Green NC□ 184AA14 Omit Armrest NC □ 184C128 Copper NC 184C8 Yellow NC

□ 184C6 Forest Green NC 184C112 Desert Camo $295.00ARM PAD - HEIGHT ADJUSTABLE □ 184C127 Fuchsia NC 184C43 Mossy Oak $295.00Armpad for flip back and single post only. Contour pad not recommended for tray tables □ 184C126 Glow NC 184C42 Stars & Stripes $295.00Contour only available w/ single post height adjustable. □ 184C116 Matte Black NC 184C108 Zebra $295.00

□ 184AM23 Desk Length - Classic (10") NC □ 184C117 Matte Green□ 184AM21 Desk Length - Contour (10") NC□ 184AM24 Full Length - Classic (14") NC □ 184AM22 Full Length - Contour (14") NC

Zebra NA w/Black. Must choose a color or default will be white.

Specifications are subject to change without notice. Copyright © 2009, Sunrise Medical (US) LLC. Quickie 2 "Easy"- of 3 119128 Rev EORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.com

To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part number must be filled out with desired width and depth

JAY Bundled CushionCushion Name/Part:Width: Depth:

Price List184JC20

Q2 Short "Easy", November 2012

*Download a QR reader to your Smartphone to access the

Quickie 2 product page.

ADDITIONAL INFORMATION

ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2009, Sunrise Medical (US) LLC. Quickie 2 "Easy"- of 3 119128 Rev E

Q2 Website

Rear Tire Min RSH Max RSH20" Pneumatic 13.5 19.020" Poly 13.5 19.022" Pneumatic 14.0 20.022" Poly 14.0 20.022" Kik 13.5 19.524" Pneumatic 14.5 21.024" Poly 14.5 21.024" Kik 14.5 20.5

Rear Side Frame Min RSH Max RSHCurved 13.5 21Straight 13.5 22

Axle Plate Min RSH Max RSHCurved 13.5 22Straight 13.5 22

Q2 Rear Seat Height Availability

5 4 3 2 1 5 4 3 2 1 5 4 3 2 1Std - - 16.5 17.0 17.5 Std - 16.5 17.0 17.5 18.0 Std - - 17.0 17.5 18.03/4" - - - 17.5 18.0 3/4" - - - 18.0 18.5 3/4" - - - 18.5 19.0

1 1/2" - - - 18.5 19.0 1 1/2" - - - 19.0 19.5 1 1/2" - - - 19.0 19.5Std - - 18.5 19.0 19.5 Std - 18.5 19.0 19.5 20.0 Std 18.0 18.5 19.0 19.5 20.03/4" - - - 19.5 20.0 3/4" - - - 20.0 20.5 3/4" - - - 20.5 21.0

1 1/2" - - - 20.5 21.0 1 1/2" - - - 21.0 21.5 1 1/2" - - - 21.0 21.5Std - - - - - Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - - 1 1/2" - - - - -Std - - 16.5 17.0 17.5 Std - - 17.0 17.5 18.0 Std - - 17.5 18.0 18.53/4" - - - 18.0 18.5 3/4" - - - 18.5 19.0 3/4" - - - 18.5 19.0

1 1/2" - - - 18.5 19.0 1 1/2" - - - 19.0 19.5 1 1/2" - - - 19.5 20.0Std - - - 18.0 18.5 Std - - 18.0 18.5 19.0 Std - 17.5 18.0 18.5 19.03/4" - - - 18.5 19.0 3/4" - - - 19.0 19.5 3/4" - - - 19.5 20.0

1 1/2" - - - 19.5 20.0 1 1/2" - - - 20.0 20.5 1 1/2" - - - 20.0 20.5Std - - - 19.0 19.5 Std - - 19.0 19.5 20.0 Std - 18.5 19.0 19.5 20.03/4" - - - 19.5 20.0 3/4" - - - 20.0 20.5 3/4" - - - 20.5 21.0

1 1/2" - - - 20.5 21.0 1 1/2" - - - 21.0 21.5 1 1/2" - - - 21.0 21.5

5 4 3 2 1 5 4 3 2 1Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - -Std - - - - - Std 19.0 19.5 20.0 20.5 21.03/4" - - - - - 3/4" - - - 21.5 22.0

1 1/2" - - - - - 1 1/2" - - - 22.0 -Std - - - - - Std - - - - - 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - -Std - - - 18.5 19.0 Std - - - - 19.53/4" - - - 19.5 20.0 3/4" - - - - 20.0

1 1/2" - - - 20.0 20.5 1 1/2" - - - - 21.0Std - - 19.0 19.5 20.0 Std - - - 19.5 20.03/4" - - - 20.0 20.5 3/4" - - - 20.5 21.0

1 1/2" - - - 21.0 21.5 1 1/2" - - - 21.0 21.5Std - 19.5 20.0 20.5 21.0 Std - 19.5 20.0 20.5 21.03/4" - - - 21.0 21.5 3/4" - - - 21.5 22.0

1 1/2" - - - 22.0 - 1 1/2" - - - 22.0 -

* Values Given are Estimates. Actual seat to floor height may vary based on seat depth and front seat to floor height selection. Chart shows available options on a standard frame, not all seat to floor heights may be available with a hemi frame.

*Rear Tire, Side Frame and Axle Plate Selection dictate seat height availability. Not ALL Combinations are possible within acceptable seat height ranges.

6"

7"

Multi Position Short

Multi Position Tall

3"

5 1/4"

All 4" CastersFork Size Stem Size Bolt Position

6"

7"


Multi Position Tall

3"

5 1/4"


Multi Position Tall

3"

5 1/4"

6"

7"

6"

7"


Multi Position Tall

3"

5 1/4"

Fork Size Stem Size Bolt Position 8" Casters

Bolt Position


Multi Position Tall

3"

5 1/4"

6"

Fork Size Stem Size Bolt Position


7"

All 8" x 1.5" Casters

*Quickie 2 Seat To Floor Height Matrix - Standard Frame (Hemi subtract approx 2")

All 6" CastersFork Size Stem Size

ST: ZIP:( ) Fax: ( )


Hemi frame lengths NA w/ Xtender Power Assist and w/ hemi hangers only

12" 184SD6 13"

184SD67

$6,595.00

NC

NC

NC

Frame Width

K0108

184W3

Heavy Duty (18"-22" w. only) NA w/ Xtender or Small Frame. Includes Reinforced Back Upholstery & Stabilizer Bar.

14"

Xtender Handrim Options

2. XTENDER POWER ASSIST OPTIONRear axle position available 15.5"-17.5". Front seat height must be greater than rear and NA w/ Rounded frame. NA with 3/4" & 1 1/2" caster stems - OR - Depth Adj. Back, HD Package or Transit Option. Rear seat heights of 19"-21" available through Built 4 Me.

Xtender Power Assist Xtender Accessory184XA1 Spare NiMH Power Pack - NICKEL $1,395.00

Xtender Wheel Options

$450.00

184XH3 Plastic Coated NC184XH4 Stainless Steel NC

3. FRAME SET UP

Rear Frame Type (265 lbs. Weight Capacity)184RS1 Rear Side Frame Straight NC E2201

E2201

184W10

184W5

184W7184W8184W9

NC

184W11

184W12

NCNCNCNCNC

E2201

184W6

184W4

Heavy Duty Package (350 lbs. weight capacity)

184HV1

$195.00

Rear Side Frame Rounded NA w/ Xtender Power Assist 184RS2

Depth Adjustable Back (DAB) NA w/ swing-away, flip-back armrests, or Xtender. Backrest set 2" rear of seat tube w/ 1" adjustable forward.

184RS3

20"

21" (Only Avail. w/ Heavy Duty)

16" 17" 18"

22" (Only Avail. w/ Heavy Duty)

$500.00

Seat Depth184SD5

184W13

15" NC

15"

12" NC13"

17" NC

$450.00

19" $450.00

NC184SD7 14" NC

184FL9

Confirmation Email: Ship To City:

K0005 Quickie 2 $2,050.00

184SD9184SD69

SPARE 24" Spoke Pneu Plastic $90.00

19" 184SD13 E2203 20"

16" NC

Dealer Phone:

Dealer Contact: Ship To:Dealer Address: Attention:

Address:

Confirm Via:

1. FRAME STYLE

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.

Fax Email

E2211E2212 SPARE 24" Spoke Pneu Alum

184WM32

E0986

Quickie 2August 2013EIQ2N

E1236 coding still applies for EIQ2N with certain sizes

Mark For: Submitting for: Quote OrderDate: PO#:

Dealer Acct #:

Frame Length

184FL83 Small (12"-14") NC

NC

$475.00

184XA4 E2211E2213

Dealer: ADDITIONAL SHIPPING INFORMATION

Address:Dealer City:

184SD71

184FL17 Hemi (13"-16")

Ship To Phone:

184XA2

Regular (13"-16")

$75.00184SD70 18" NC

NC

Option # HCPCS Definition Price Option # HCPCS Definition Price

NC184FL25 X-Long (17"-20")(Steel Reinforced) NC184FL18 Long (15"-18")

184XA7

NC184FL24 Long Hemi (15"-18") NC184FL29 X-Long Hemi (17"-20")(Steel Reinforced) NC

Spare NiMH Power Pack - LITHIUM

184XT3 E0986 Xtender Power Assist 4X Multiplierw/ Pneumatic Tires - LITHIUM

184XT2 Xtender Power Assist 4X Multiplierw/ Pneumatic Tires - NICKEL $1,795.00

Frame Width (Continued)

$7,595.00

Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie 2 112252 REV. O

Page 1

Please see matrix on Page 8 for additional information

Please see matrix on Page 8 for additional information

184SH12 15" NC184SH42 14.5" NC

4. FRONT SEAT HEIGHT SET UP

Front Seat Height

184SH41 NC

Caster Options

184SH13 15.5" NC

184SH14 16" NC

184SH15 16.5" NC

184SH16 17" NC

184SH17 17.5" NC

184SH18 18" NC

20"

184SH20 18.5" NC

184SH21 19" NC

NC

184SH23 19.5" NC

184SH26 NC184SH24

8" Polyurethane

NC

184SH27 NC

184SH2921" (Only available on swing away)

$70.00

184CW72

Caster Wheels

184CW31

184CW6

184CW32

184CW44 4" x 1.25" Semi Pneumatic $55.00

184SH36 NC

NC

184CW64 4" x 1.5" Aluminum Soft Roll $135.00

184CW5 5" Low Profile Polyurethane NC

$145.00

184CW51 5" Micro Lighted $85.00

5" Soft Roll (Grey)NA w/ Frog Legs $85.00

184CW65184CW7 5" x 1.5" Semi-Pneumatic

184CW66 5" x 1.5" Aluminum Soft Roll

$395.00E1015 Frog Legs Suspension (101-190 lbs)

184CF55

4" Low Profile PolyurethaneNA w/ HD package

$100.005" x 1" Aluminum Polyurethane

4" x 1" Aluminum Polyurethane $80.004" Micro Lighted

NC$395.00$395.00

184CF29 8" x 2" Fork

184CF53 E1015 Frog Legs Suspension (0-100 lbs)

184CF54

184CW16 7" Polyurethane 184CW68 6" x 1.5" Aluminum Soft Roll

All 8" casters NA w/ 90° hangers, ELRs and small frame. Also NA w/ combination of regular front frames, composite footplates, 24" wheels, and 70/80/90 degree hangers. See matrix on page 8.

184CW1 3" Micro NC

6" x 1.5" Semi Pneumatic

184CW34 6" Polyurethane NC

21.5" (NA with Hemi Frame)

22" (NA with Hemi Frame)

$145.00

NC

$75.00

8" Pneumatic

$160.00$85.00

NC

$85.00

$75.00

NC

184CF23 7" Fork

E1015 Frog Legs Suspension (191-265 lbs)

$85.00

NC184CF12 5 1/4" Fork NC

184CF17 6 " Fork

184CF62 3" Fork NC184CF47 Multi Position Fork- Tall NC

Caster Fork

184CF46 Multi Position Fork-Short NC

184CW3

184CW39 8" x 1.5" Semi Pneumatic

184CW33 E2214E2215

184CW21

184CW35

E2214E2215

6" Pneumatic

184CW36 E2214E2215 8" x 2" Pneumatic

184CW22 E2214K0108 8" x 2" Pneumatic w/Airless Insert $225.00

14" (Only available on Hemi Frame)

20.5" (Only available on swing away)

Caster Pin Locks (N/A w/8"x2")NA w/ Xtender, Frog Legs or Transit $195.00K0073184OC1


Page 2

NC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NC


Required w/ extension tube mounted hangers. See leg length matrix

184F8 K0040 90D Aluminum Angle Adj (16"-22"w) $185.00

184HL4 Omit Heel Loop184HL6

K0040 Composite Angle Adj (16"-22"w) $150.00184F3 K0040 Aluminum Angle Adj (16"-22"w) $185.00

Omit Leg Strap

NCNC

14.0"

Notes:1. 2" & 4" extensions for front mount hangers shipped separate, not mounted.2. Front seat height must be at least 2" taller than lower leg length on all swing in/out hangers.3. Front seat height must be at least 2" taller than maximum lower leg length on all front mount hangers.

14.0"14.0"14.0"14.0"

18.0"14.0"16.5"18.5"

15.0"17.5"14.0"16.0"

15.5"17.5"14.0"16.0"

15.0"15.0"17.0"15.0"

Hanger ExtensionSeat Sling to Top of

Footrest*Minimum Allowable

FSH

70° Swing In/OutStd & Hemi

Short

60° Swing In/Out Hanger

184HL5 K0038 Leg Strap

ELR184E15 Long ELR (ELR only) NC

184HL1 E0951

184E12 Short ELR (ELR only) NC

Short 14.0" 18.0"Long 15.0" 20.0"

ALRMedium 15.0" 17.5"

Long 17.5" 20.0"

90° Front Mount No Ext 5.5" 11.5"

*80° Front MountNo Ext 6.0" 12.0"2" Ext 6.0" 14.5"4" Ext 6.0" 16.5"

*70° Front MountNo Ext 6.0" 11.5"2" Ext 6.0" 14.0"4" Ext 6.0" 16.0"

70° Swing In/Outw/Platform Flip Up

Short 13.0" 15.5"Long 15.5" 20.0"

60° Swing In/Outw/Platform Flip Up

Short 11.5" 14.5"Long 14.0" 18.5"

13.0" 17.0"Medium 13.5" 18.5"

Long 15.5" 20.5"

60° Swing In/OutShort 13.0" 16.5"

Medium 13.0" 18.0"Long 15.0" 19.5"

Min Max

5. HANGER & FOOTPLATE OPTIONS

HangersRecommend 2" less than FSTFH. NA w/ direct mount hangers

Lower Leg Length Setting

70° Swing In/Out Hanger NC

Front mount hangers only available w/ aluminum angle adj footplates

184H86

NC184H85

184H89 70° Swing In/Out Front Mount NC

184H88 70° Hemi Swing In/Out Hanger NC

Elevating Hanger Only available w/ alum or angle adj footplates. NA w/ short extension tubes

$295.00



184H32 Omit Hanger -$15.00

Footplates

Footrest Extension Tubes

K0040 Platform Flip UpAvailable w/ 60°, 70°, or hemi hangers

$190.00

Short NC

NC184F1 Composite (13"-22"w)

NC

184F48

184F271

184F5 Aluminum Footplate Available w/ ELRs

184F7 Omit Footplate & Ext Tube -$15.00

184E2 Medium NC

184E5 Long NC

184E1

184E16 K0037High Mount NA w/ one-arm drive option or ELR's or front mount. Only available w/angle adj footplates

Heel Loop $30.00

184E23 2" - Front Mount Only NA with 6", 7" or 8" caster, 90 °hangers or ELR's

184E24 4" - Front Mount Only NA with 6", 7" or 8" caster, 90 °hangers or ELR's

184LO13 15.0"184LO02 9.5" 184LO14 15.5"184LO01

184LO04 10.5"

$35.00

9.0"

184LO03 10.0"

$55.00

$55.00

$55.00

Footplate Options (Ext Tube & Direct Mount)

184LO16 16.5"184LO15 16.0"

184LO19 18.0"

184LO17 17.0"184LO18 17.5"

184LO07 12.0"184LO08

184LO05 11.0"184LO06 11.5"

184LO21 19.0"12.5"

184LO22 19.5"

184LO20 18.5"184LO09 13.0"184LO10 13.5"184LO11 14.0"184LO12 14.5"

184LO23 20.0"184LO24 20.5"

Lower Leg Length Matrix

184H24 K0053

Articulating Hanger Available w/ composite & alum. angle adj. footplates 15-22' widths only. NA w/ Push To Lock Wheel Locks

$350.00

184H14 E0990

$295.00184H42 E0990Elevating Hemi Hanger NA w/ locking angle adj footplates. 14"- 22" W available w/ alum or angle adj


Page 3

NC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NCNC NC

NC

Right Hand Mount Left Hand Mount

Mountain Tire Only available on 24" Mountain Rear Wheel

184RH40

Schwalbe Marathon 24 24,25,26

Rear Wheel Tire

184RT1

184HM1 NC

184HM2 NC

184OA2 Standard Handrim NC

Straight

Axle PlateCurved

24" HP Clincher

25" Kik

24" Schwalbe

184OA1 Small Handrim (NA w/ 20" wheels) NC184AL16 E0958 One Arm Drive Adj. Axle Plate

22.0"

$850.00

184RH19

184RT12 E2211E2212

17.0" 184RH39 21.5"

Rear Tire

E2211E2212 Pneumatic NC

24,25

24" Knobby

25" Schwalbe

Amputee

14.5" 20.5"24" Kik

19.5"22" HP Clincher 13.5" 19.5"

24,25

22,24,25,26

Knobby V-TRAK 24 24

High Pressure Clincher 22,24,25,26

24,26

Full Poly Tire 20,22,24 20,22,24

Pneumatic w/Airless Insert 20,22,24 20,22,24,26

SpinergyTirePneumatic 20,22,24 20,22,24,26 24,26

Wheel Mag

DAB

22,24

22,24

22" = 489 mm 24" = 540 mm

24,25,26

Kik Mako Black

$95.00

Lite Spoke Ultra Lightweight

$125.00

184RT22 E2218 Kik® Mako Black $95.00

184RT21 E2211E2212 Schwalbe Marathon Plus Evolution

$95.00

184RT27 E2211E2212 Knobby V-TRAK $95.00

184RT6 E2211E2212 High-Pressure Clincher

$80.00

184RT3 E2218 Full Poly NC

184RT2 E2211E2213 Pneumatic Airless Insert

184RW25 Omit Rear Wheel and Axle(Intended Size for Set Up ______ ) -$55.00

26" Spinergy LX Black $895.00

24" Mountain


$250.00



25" Spinergy SPOX Black $695.00




22" Ultra Lightweight Spoke Wheel $250.00


25" Lite Spoke Wheel NC

26" Lite Spoke Wheel $80.00



20" Mag Wheel NC

22" Mag Wheel NC

24" Mag Wheel NC

184RW98

184RW94184RW77184RW78184RW28

184RW90184RW91

Not applicable w/ Xtender Power Assist Option. Ultra Lightweight Wheels only available w/ Alum Anodized Handrim. Handrims cannot be omitted on Lite Spoke Wheels. Contact Built 4 Me for Spinergy color options.

184RW3184RW8184RW1

184RW99184RW40

184RW95184RW96184RW97184RW32

184RW49 Omit Rear Wheel (Use with Xtender) NC

184RW92184RW93

184RW50


184RH18 16.5" 184RH23 21.0"184RH17 16.0" 184RH38 20.5"184RH16 15.5" 184RH22 20.0"184RH15 15.0" 184RH37 19.5"184RH14 14.5" 184RH21 19.0"184RH13 14.0" 184RH27 18.5"184RH12 13.5" 184RH20 18.0"

6. REAR SEAT HEIGHT SET UP

Rear Seat Height

184RH11 13.0" 184RH26 17.5"

Rear Seat Height Availability Matrices

Max RSH

22" Schwalbe 13.5"

13.5" 22.0"Offset 13.5" 22.0"

21.5"

13.5"

14.5"

15.0" 21.0"

20.5"22.0"

15.5"

Min RSH

20" Pneumatic 13.5"

26" HP Clincher

24" Pneumatic 14.5" 21.0"

14.5" 20.5"24" Poly

Min RSH Max RSH Rear Side Frame21.0"

20" Poly 13.5" 19.0" Straight 13.5" 22.0"19.0" Curved 13.5"

22.0"22" Poly 14.0" 20.0"22" Pneumatic 14.0" 20.0" 14.0"

21.0"

21.0"

14.5"

21.0"

14.5" 21.0"

15.0"

14.5" 20.5"

22.0"22.0"

13.5"

15.5" 21.5"

Min RSH Max RSH

Axle Plate

One Arm Drive

26" Pneumatic 16.0"

26" Schwalbe

25" HP Clincher 15.0"24" Mountain

184AL33 Standard Adjustable

Curved Adjustable $55.00

NC

NC

184AL5

184AL6 E0959 Amputee Adjustable Available w/ SPHA armrests

184AL29 Offset Adjustable Rear seat height will be 1/4" lower than standard RSTFH

Rear Wheel Type

Rear tire, side frame, and axle plate selections dictate seat height availability. *Not all combinations are possible within acceptable seat height ranges

NA w/ Xtender, 12", 21" & 22" wide, HD package, curved & amputee axle plates, and small tray table. NA w/ combination of Padded SA arms and Anti tips. Only available w/ 20", 22", 24" mag wheels.

$175.00

21.5" & 22" only available with amputee or straight axle plate & mountain wheel


Page 4

NC NCNC NCNC NCNC NCNC NCNC NC NC

Diagram of DAB in Appendix on page 8. Swing away height range is 22"-28"

184HR7 Omit Handrim Option may not be available on all handrims

184HR24 Spinergy Flex Rim Available on 24" & 25" Spinergy LX wheel $525.00

184HR31 Natural Fit LT- Super Grip $395.00184HR30 Natural Fit LT- Standard Grip $375.00184HR23 Natural Fit - Super Grip $395.00184HR22 Natural Fit - Standard Grip $375.00184HR4 Plastic Coated $95.00

Handrim

184HR1 Aluminum Anodized NC

NC

$240.00184HR88 Oblique NA w/ Xtender, plastic coated handrims. Only available with 24" or 26 " Mag or Lite Spoke rims.

184AX1Quad Quick Release Mag and Mountain Wheel only $90.00

6. REAR SEAT HEIGHT SET UP (CONT.)

AxleQuick Release Steel NC

184AX11

Low (9"-12")

184BT22 Angle Adjustable Back (5"-7")

7. BACKREST

Back Type184BT10 Standard NC

Back Height

Angle Adjustable Back (3-5") $165.00

Depth Adjustable (Required with DAB) NC184BT6

Backrest Upholstery (Standard or Angle Adjustable)184BU1 Standard Upholstery NC

184BU8

184BT20

Tension Adjustable Upholstery NA w/ Depth Adj. Back $175.00

184BP8 Omit Back Post & UpholsteryUse w/ DAB solid back & Hardware

-$35.00

Back Height Setting (Std or Angle Adjustable)184UX4 9"

184BU23 Depth Adjustable Solid Back $195.00

184BU14 Omit Back Upholstery -$15.00

184BU28 Omit DAB Solid Back and Hardware NC

184BU29 Omit DAB Solid Back Include Hardware $80.00

NC

184B5 Medium (12"-15") NC

184B9 Tall (16"-19") NC

184B1

184B66 Depth Adjustable 12" NC





16"184UX6 10" 184UX20 17"

184UX18

184UX8 11" 184UX22 18"184UX10 12" 184UX24 19"184UX12 13" 184UX26 20"

J3 Back (See J3 Order Form) Price List

184UX14 14" 184UX28 21"20" & 21" only w/ Ang Adj Back184UX16 15"

Back Post Options (Std or Angle Adjustable)

184BP1 Push Handle Straight NCOmit push handles NA w/ stabilizer bar or transit

$165.00

$25.00

Backrest Option

184OD4 Reinforced Upholstery Only avail w/ Std Back Upholstery & HD package

$50.00

JAY Back (Optional)184JB01

184BP2 Omit Push Handle Straight (NA w/HD) NC

184BP4 Omit Push Handle 8° (NA w/HD) $25.00

Angle Adj. Straight Push Handles NC

184BP6 Angle Adj. Omit Push Handles NC

184BP3 Push Handle 8° Med or Tall only. NA w/ Angle Adjustable Backrest

Back Post Options (Depth Adjustable Back)

184BP33 DAB - Swing Away Stroller Handles $100.00

184BP5

184BP27 DAB - Post Standard (19") NC

184BP28 DAB - Post Medium (22") NC

184BP29 DAB - Post Tall (25") NC

Stabilizer Bar

184SZ1 Stabilizer Bar Standard with Heavy Duty Package $105.00

Stroller Handles

Only available w/ omit push handles. NA w/Xtender, DAB, amputee axle plate, push handles when angle adjustable back is selected, flip-back or flip-back height adjustable armrests, and JAY backs.

184SR2 Regular Stroller Handles $125.00

184SR3 Tall Stroller Handles $125.00

Pivot Regular set at 3" 12" 13" 14" 15" 16" 17" 17" 18" 19"

Angle Adjustable Backrest Chart

Back Tube Height Low Medium Tall

Pivot Regular set at 4" 13" 14" 15" 16" 17" 18" 18" 19" 20"Pivot Regular set at 5" 14" 15" 16" 17" 18" 19" 19" 20" 21"Pivot Tall set at 5" 14" 15" 16" 17" 18" 19" 19" 20" 21"Pivot Tall set at 6" 15" 16" 17" 18" 19" 20" N/APivot Tall set at 7" 16" 17" 18" 19" 20" 21" N/A

Adjustable Pivot Point Measurement from Seat SlingIf back height option is not chosen, middle option will be present

Handrim (Cont)

Natural Fits available in 22", 24", and 25". Handrim selection NA w/ Xtender. Ultra lightweight wheels only available w/ alum anodized handrim. Plastic coated limited to certain rims and sizes


Page 5

9" 10" 11" 12" 13"

NA w/ ergo scissor or compact wheel locks

Angle Adjustable Backrest Pivot HeightStandard push handles only. Some interference w/ Padded SA arms. NA w/ flip-back or flip-back height adjustable armrests. Back Angle - 12° NC

184AH1 Angle Adjustable Pivot 3" NC





Preset Angle Adjustable Backrest (-15° to +3°) (Optional)184BD5 Back Angle - 15° NC

184BD4184BD3 Back Angle - 6° NC

184BD2 Back Angle - 0° NC

184BD1 Back Angle +3° NC

Military Service Patches (Optional)Only available on tension adjustable upholstery and J3 Back

184VU1 Marines Patch $90.00

184VU2 Army Patch $90.00

184VU3 Navy Patch $90.00

184VU4 Air Force Patch $90.00

184VU12 Coast Guard Patch $90.00

184VU5 Purple Heart Patch $90.00

184VU8 Purple Heart with Marines Patch $145.00

$145.00184VU9 Purple Heart with Army Patch $145.00

E0973 Padded Swing-Away STD (9" to 13") $175.00

7. BACKREST (CONT.)

184VU13 Purple Heart with Coast Guard Patch $145.00184VU11

8. ARMREST

Padded Swing AwayNA w/ DAB, transit, Xtender or Amputee axle. Some limitations may exist with integral push handles, some RSTFHs and wheel sizes

Purple Heart with Air Force Patch $145.00184VU10 Purple Heart with Navy Patch

Flip Up (For use with Depth Adjustable Back)Requires an Armpad Foam from the Arm Pad section below

Setting184AA18

Height Adjustable184AA11 E0973 Single Post Hgt. Adj. Std $260.00

184AA29 E0973 Single Post Hgt. Adj. Low $260.00

Flip BackNA w/ DAB, Xtender, small frame, amputee axle, highest axle on rounded rear frame, or angle adjustable back.

184AA6 E0973 Flip Back Height Adj (Classic) $275.00

184AA65 E0973 Flip Back Height Adj (LITE) $275.00

184AA5 K0015 Flip Back NC

184AA7 E0973 Length Adjustable Locking Flip-up $260.00

184AA1 E0973 Adj. Locking Flip-up $250.00

Omit Armrest184AA14 Omit Armrest NC

Armpad for Height AdjustableFor flip back, single post, and flip up- contour pad not recommended for tray tables. Contour only available with single post height adjustable.

184AM23 Desk Length - Classic (10") NC

184AM21 Desk Length - Contour (10") NC

184AM24 Full Length - Classic (14") NC

184AM22 Full Length - Contour (14") NC

184AM9 Armpad Foam - Short (Flip Up armrests) NC

184AM10 Armpad Foam - Long (Flip Up armrests) NC

9. KEY OPTIONS & ACCESSORIES

Wheel LockErgo & compact NA w/ short frame or amputee axle plate. Additional No Gos may exist depending on wheel size and position

184WL1 High Mount Push NC 184WL12

184WL24

184WL2 High Mount Pull NC

184WL27 Ergo Scissor $100.00

184WL30 Compact $125.00

184WL10 Omit NC

Do Not Mount NC

Extension Handle

184EH7 E0961 Extension Handle (Pair) $60.00

184WL23

Wheel Lock OptionUnilateral Wheel Lock Right $200.00

Unilateral Wheel Lock Left $200.00

A

B

PSIS

SEATING SURFACECUSHION THICKNESS

TO DETERMINE THE PROPER PIVOT-POINT HEIGHT,MEASURE BETWEEN THE PSIS AND THE TOP OF THESEATING SURFACE (A), THEN ADD THE THIICKNESS OFTHE CUSHION (B) IF ONE IS USED. IF A DROP-SEAT FALLSBELOW THE SEAT RAILS, SUBTRACT THIS DISTANCEFROM THE OVERALL VALUE.

REGULAR3”– 5”

TALL5”– 7”

3°15°

REFER TO CHART IN DETERMINING PUSH

HANDLE LENGTH


Page 6

Only available w/ Mag, Mountain, and Lite Spoke wheels


184A31

184C14 Candy Purple NC

E0950 Medium (15"-17") $250.00

JAY Cushions (Optional)

184JC20

JAY Bundled Cushion

Price ListCushion Name or Part #

Width: Depth:

184C116 Matte Black NC

E0950

Tray Tables184A30 E0950 Small (13"-14") $250.00

Matte Green NC

184A32 Large (18"-20") $250.00

184A33 E0950 X-Large (21"-22") $250.00Side Guard

Plastic side guards NA w/ height adj. arms. Side guard interference w/ Padded SA arms at some heights may exist.

184SG33 K0108 Plastic Standard (8.5" High)

184A82 Caddy (NA w/ front mount hangers)

Grade AidOnly available w/ high mount push or pull to lock wheel locks on pneumatic or pneumatic w/ airless tire options

184GA1 E0974 Grade Aid $150.00

184CU1 E2601 2" Cushion $95.00

9. KEY OPTIONS & ACCESSORIES (CONT.)

Seat Sling184SL1 Standard Seat Sling NC

Plastic Low (6.5" High) $125.00

E0971 Rear Anti-Tip (Included with Xtender) $135.00

184SL6 Omit Seat Sling -$15.00

Cushion

$125.00

184TO1 Transit System $315.00

Backpack

Anti-Tip184AT1

184SG29 K0108

184A1 Quickie Backpack Black $55.00

184A2 Quickie Kids Backpack Black $50.00

Seat Pouch184A8 Quickie Seat Pouch Black $45.00

Additional Cover & Pack Accessories184A500 Gel Cover Hanger/Frame $105.00

184A994 Gel Cover Swing Away Arm $105.00

Positioning Belts184A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00

184A117 E0978 Belt 2" Aircraft Buckle w/Clamps $110.00

$50.00184A118 E0978 Belt 2" Aircraft Buckle Pad w/Clamp $120.00

Spoke Guards

184A302 K0065 Quickie Clear Spoke Guards $115.00

184A23 K0065 Black Spoke Guards $115.00

$45.00

184A49 E2207 Crutch Holder $195.00

Miscellaneous

184A55 K0038 Extra Leg Strap Black $30.00

184IG2 Impact Guard Neoprene $85.00

184A73 K0105 IV Holder $275.00

184A145 E2208 O2 Holder (NA w/ transit) $310.00

184A83 Tool Kit $45.00

Frame Color184C2 Black NC

184C10 Black Opal NC

184C38 Blue Opal NC

184C36 Candy Blue NC

184C35 Candy Red NC

184C128 Copper NC

184C6 Forest Green NC

184C127 Fuchsia NC

184C126 Glow NC

184C4 Midnight Purple NC184C117

184C5 Pearl Pink NC

184C103 Rootbeer NC

184C114 Sparkle Silver NC

184C113 Titanium Color Paint NC

184C11 Toxic Green NC

184C8 Yellow NC

Mossy Oak Camouflage $295.00

Custom Frame Color184C112 Desert Camouflage $295.00

184C43

Built for MeTo inquire about any unique customization for Quickie products, contact: Phone: (800) 333 - 4000, Fax: (800) 333 9011

184C42 Stars & Stripes $295.00

NA w/ padded swing away arms, stroller handles or Xtender

Transit Option

184C108Zebra (Choose above base color) Std with White unless above base paint is chosen NA w/ Black

$295.00

184A120 K0108 Positioning Belt Slide Clamps


Page 7

10. APPENDIX

Quickie 2 Seat To Floor Height Matrix - Standard Frame *Hemi options will result in a reduction of approx 1 3/4 "* Values Given are Estimates. Actual seat to floor height may vary based on seat depth and front seat to floor height selection.

SEAT DEPTH

FRAME DEPTH

SLING DEPTH

.05”1.50”

2.50”

3.50”

SEAT SLING TO PUSH HANDLE MEASUREMENT

BACKREST MOUNTING HARDWAREWILL AFFECT SEAT DEPTH

5 4 3 2 1 5 4 3 2 1 5 4 3 2 1Std - - 16.5 17.0 Std - - 16.5 17.0 17.5 Std - 16.5 17.0 17.5 18.03/4" - - - 17.0 17.5 3/4" - - - 17.5 18.0 3/4" - - - 18.0 18.5

1 1/2" - - - 18.0 18.5 1 1/2" - - - 18.5 19.0 1 1/2" - - - 19.0 19.5Std - - - 18.5 19.0 Std - - 18.5 19.0 19.5 Std - 18.5 19.0 19.5 20.03/4" - - - 19.0 19.5 3/4" - - - 19.5 20.0 3/4" - - - 20.0 20.5

1 1/2" - - - 20.0 20.5 1 1/2" - - - 20.5 21.0 1 1/2" - - - 21.0 21.5Std - - - - 15.0 Std - - - - - Std - - - - -3/4" - - - - 15.5 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - 16.5 1 1/2" - - - - - 1 1/2" - - - - -Std - - - - 17.0 Std - - 16.5 17.0 17.5 Std - - 17.0 17.5 18.03/4" - - - - 18.0 3/4" - - - 18.0 18.5 3/4" - - - 18.5 19.0

1 1/2" - - - - 18.5 1 1/2" - - - 18.5 19.0 1 1/2" - - - 19.0 19.5Std - - - - 18.0 Std - - - 18.0 18.5 Std - - 18.0 18.5 19.03/4" - - - - 18.5 3/4" - - - 18.5 19.0 3/4" - - - 19.0 19.5

1 1/2" - - - - 19.5 1 1/2" - - - 19.5 20.0 1 1/2" - - - 20.0 20.5Std - - - - 19.0 Std - - - 19.0 19.5 Std - - 19.0 19.5 20.03/4" - - - - 19.5 3/4" - - - 19.5 20.0 3/4" - - - 20.0 20.5

1 1/2" - - - - 20.5 1 1/2" - - - 20.5 21.0 1 1/2" - - - 21.0 21.5Std - - - - - Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - - 1 1/2" - - - - -Std - - - 16.5 17.0 Std - - 16.5 17.0 17.5 Std - - - 17.5 18.0

1 1/2" - - - 18.0 18.5 1 1/2" - - 18.0 18.5 19.0 1 1/2" - - - 19.0 19.5

5 4 3 2 1 5 4 3 2 1 5 4 3 2 1Std - - 17.0 17.5 18.0 Std - - - - 19.0 Std - - - - -3/4" - - - 18.5 19.0 3/4" - - - - 19.5 3/4" - - - - -

1 1/2" - - - 19.0 19.5 1 1/2" - - - - 20.5 1 1/2" - - - - -Std 18.0 18.5 19.0 19.5 20.0 Std - 19.5 20.0 20.5 21.0 Std - - - - -3/4" - - - 20.5 21.0 3/4" - - - 21.0 21.5 3/4" - - - - -

1 1/2" - - - 21.0 21.5 1 1/2" - - - 22.0 - 1 1/2" - - - - -Std - - - - - Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - - 1 1/2" - - - - -Std - - 17.5 18.0 18.5 Std - - - 18.5 19.0 Std - - - 18.5 19.03/4" - - - 18.5 19.0 3/4" - - - 19.5 20.0 3/4" - - - 19.5 20.0

1 1/2" - - - 19.5 20.0 1 1/2" - - - 20.0 20.5 1 1/2" - - - 20.0 20.5Std - 17.5 18.0 18.5 19.0 Std - - 19.0 19.5 20.0 Std - - 19.0 19.5 20.03/4" - - - 19.5 20.0 3/4" - - - 20.0 20.5 3/4" - - - 20.0 20.5

1 1/2" - - - 20.0 20.5 1 1/2" - - - 21.0 21.5 1 1/2" - - - 21.0 21.5Std - 18.5 19.0 19.5 20.0 Std - 19.5 20.0 20.5 21.0 Std - 19.5 20.0 20.5 21.03/4" - - - 20.5 21.0 3/4" - - - 21.0 21.5 3/4" - - - 21.0 21.5

1 1/2" - - - 21.0 21.5 1 1/2" - - - 22.0 - 1 1/2" - - - 22.0 -Std - - - - - Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - - 1 1/2" - - - - -Std - - - - 18.5 Std - - - - - Std - - - - -

1 1/2" - - - - 20.0 1 1/2" - - - - - 1 1/2" - - - - -

5 4 3 2 1 5 4 3 2 1Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - -Std - - - - - Std 19.0 19.5 20.0 20.5 21.03/4" - - - - - 3/4" - - - 21.5 22.0

1 1/2" - - - - - 1 1/2" - - - 22.0 -Std - - - - - Std - - - - -3/4" - - - - - 3/4" - - - - -

1 1/2" - - - - - 1 1/2" - - - - -Std - - - - - Std - - - - 19.53/4" - - - - - 3/4" - - - - 20.0

1 1/2" - - - - - 1 1/2" - - - - 21.0Std - - - - - Std - - - 19.5 20.03/4" - - - - - 3/4" - - - 20.5 21.0

1 1/2" - - - - - 1 1/2" - - - 21.0 21.5Std - - - - - Std - 19.5 20.0 20.5 21.03/4" - - - - - 3/4" - - - 21.5 22.0

1 1/2" - - - - - 1 1/2" - - - 22.0 -Std - - - 19.5 20.5 Std - - - - -3/4" - - - 20.0 21.0 3/4" - - - - -

1 1/2" - - - - 22.0 1 1/2" - - - - -Std - - - - - Std - - - - -

1 1/2" - - - - - 1 1/2" - - - - -

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

6"

7"

8" X 2"

Frog Legs


Multi Position Tall

3"

5 1/4"

All Other 8" CastersFork Size Stem Size Bolt Position

Fork Size Stem SizeBolt Position

All 8" x 1.5" CastersFork Size Stem Size

Bolt Position

Fork Size Stem Size Bolt Position

All 6" Casters

Bolt Position


Multi Position Tall

3"

5 1/4"

6"

Fork Size Stem SizeBolt Position


7"

8" X 2"

Frog Legs

All 5" Casters

All 8" x 2" CastersFork Size Stem Size Bolt Position

All 7" Casters

All 4" CastersFork Size Stem Size

Depth Adjustable Back Frame


Page 8

o o


ST: ZIP:o o ( ) Fax: ( )

a a

o

See FIGURE 1 Measure from front frame to flooro

o o

o o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

184SD9 16" NCNC

NC$450.00184W11

NCNC

See FIGURE 2 Frame inset is the distance from the outside of the seat tube tothe outside of the footrest. Footrest width = frame width minus 2.

Frame Inset (Fixed Front Only)

184FF1

Seat Depth

NCNCNC

184SD67 15" NC

184SD69

NC

NCo 184FF2

184FS33

E2201

184W6184W7184W8184W9184W10

14"15"

NC

Frame Width

See FIGURE 2 Measured from outside of seat tube to the outside of oppositeseat tube.

184W5

Fixed Front 80o

20"

16"17"18"19"

0"1" NA for 14" and 15" Wide usingcomposite footrest

17" NC

18" NC

184SD71

184FL9

$75.00

184FL83 NCNC

Small Fixed front only 14"-16"


$475.0019"

184SD13 E2203 20"

184SD70

Dealer Phone:

Dealer Contact: Ship To:Dealer Address: Attention:


Quickie 2 LiteNovember 2012EIQ2N

Mark For: Submitting for: Quote Order

1. FRAME STYLE & SET UP


Fax Email Ship To Phone:

Date: PO#:Dealer Acct #:

Frame Length

E1236 coding still applies for EIQ2N with certain sizes184WM58 K0005 Quickie 2 Lite

Dealer:

$2,050.00

ADDITIONAL SHIPPING INFORMATION

Address:


Confirm Via:

NC

184FL25 NC184FL18

X-Long 19"-20"Long 17"-18"

Seat Squeeze Matrix

Figure 2Figure 1

See FIGURE 1 and Seat Squeeze Matrix Measured from back canes to frontedge of upholstery.

o 184SD7 14" Front of seat sling 2" behindfront edge of frame.

Frame Style

NCNC

184FS31 Swing Away Frame184FS32 Fixed Front 70

o

Regular 14"-16", Fixed 15"-16"

Max Seat SqueezeSeat Depth14"-15" 2.0"16"-19" 2.5"

20" 3.0"

Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie 2 Lite 108610 REV. K

Page 1

o o

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o

o

184SH42 NC14.5" (Only available on Fixed Front)


Front Seat Height

o 184CP12Hemi Subtract 1 3/4 " from

Standard Front STFH Matrix

184SH12 NC15" (Only available on Fixed Front)

184SH13 NC15.5" (Only available on Fixed Front)

184SH14 NC16" (Only available on Fixed Front)

184SH15 NC16.5"

184SH16 NC17"

184SH17 NC17.5"

184SH18 NC18"

184SH20 NC18.5"

184SH21 NC19"

184SH23 NC19.5"

184SH24 NC20" (Max length for fixed front)

184SH26 NC20.5" (Only available on swing away)

184SH27 NC

184CP11

21" (Only available on swing away)

Caster Housing

o 184CW6

$195.00

Standard NC

NC

Frog Legs Suspension (101-190 lbs)

$395.00

184CW66

Caster Wheels

184CW1 3" Micro NC

o


$395.00

184CF53

NC184CF45Short Wide Fork Used with 1.25" or

1.5" wide caster


184CW72 4" x 1" Aluminum Polyurethane $80.00


5" Low Profile Polyurethane NC


5" x 1" Aluminum Polyurethane $100.00


5" x 1.5" Semi-Pneumatic $85.00

5" Soft Roll (Grey)

NA w/ Frog Legs$85.00

5" x 1.5" Aluminum Soft Roll $145.00

$395.00

NC

$75.00

Tall Wide Fork

E1015

$160.00

NC184CF32


NC4" Low Profile Polyurethane

Caster Fork

184CF46 Short Fork NC


184CW3

184CW34

184CW7

184CW65

184CW5

184CW33E2214

E22156" Pneumatic

6" Polyurethane


Caster Options

o 184OC1Caster Pin Locks NA w/ hemi caster

housing, frog legs, short wide fork

184CF55 E1015

o

E1015184CF54

Front Seat Height Matrix

Spacer None +.5" +1" None +.5" +1" None +.5" +1" None +.5" +1"

16 1/2 15 1/2 Top

17 16 Bottom Top Top

17 1/2 16 1/2 Bottom Top Middle Top Top

18 17 Bottom Bottom Middle Top Middle Top

18 1/2 17 1/2 Bottom Middle Bottom Middle Top

19 18 Bottom Bottom Middle

19 1/2 18 1/2 Bottom

17 16 Top Top

17 1/2 16 1/2 Bottom Top Middle Top Top

18 17 Bottom Top Bottom Middle Top Middle Top Top

18 1/2 17 1/2 Bottom Bottom Middle Bottom Middle Top Middle Top

19 18 Bottom Bottom Middle Bottom Middle Top

19 1/2 18 1/2 Bottom Bottom Middle

20 19 Bottom

18 17 Bottom Middle Top

18 1/2 17 1/2 Bottom Bottom Middle Middle Top

19 18 Bottom Bottom Middle Bottom Middle Top Middle

19 1/2 18 1/2 Bottom Bottom Middle Bottom Middle

20 19 Bottom Bottom Middle

20 1/2 19 1/2 Bottom

19 18 Bottom Middle

19 1/2 18 1/2 Bottom Bottom Middle

20 19 Bottom Bottom Middle Bottom

20 1/2 19 1/2 Bottom Bottom

21 20 Bottom

Standard Caster Housing (For Hemi Housing Subtract 2")Frog Legs

FrontHeight -SA Front

Frame

Fork Hole Fork Hole Fork Hole Fork Hole

3"

FrontHeight -

Fixed FrontFrame

Caste

rS

ize

Short Short Wide Tall Wide

4"

5"

6"

Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.com

Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie 2 Lite 108610 REV. K

Page 2


o o

o o

o o

o

See Extension matrix for leg length range

o

o

o

o

o

o NC o NC

o NC o NC

o NC o NC

o NC o NC

o NC o NC

o NC o NC

o NC o NC

o NC o NC

o NC o NC

184E2

184E5 Long NC

Medium NC

Extension Matrix

Recommend 2" footrest clearance to ground surface

Tubular Flip Up

Fixed front frame only$100.00

Swing - Away Hangers

Footplate mounts with Extension Tube using clamping hardware

$200.00

o 184F245 K0040

Footplates


o 184F250

184LO09

184LO07

Footplate Options

184HL1 E0951

K0040Auto Fold Angle Adj

Fixed front frame only

Lower Leg Length Setting

184LO16 16.5"

184LO15 16.0"

184LO22

184LO17 17.0"

184LO13

184LO18 17.5"

19.0"

184LO19 18.0"

184LO20 18.5"

13.0"

184LO10 13.5"

184LO11 14.0"

14.5"184LO12

184LO23 20.0"

184LO24 20.5"

184LO21

19.5"

184LO14 15.5"

15.0"

NC

184H32 Omit Hanger and Footplate -$15.00


12.0"

184LO08 12.5"

184H116

Footrest Extension Tubes

184E1

184H86 70° Swing In/Out Hanger NC

Short NC

Heel Loop $30.00

184HL5 K0038 Leg Strap $35.00

184F1 Composite (13"-22"w) NC

184F271 K0040 Composite Angle Adj (16"-22"w) $150.00

$185.00

184F48 K0040 Platform Flip Up $190.00

184F3 K0040 Aluminum Angle Adj (16"-22"w)

Short Med Long Short Long Short Long

Min 13 3/4 13 3/4 14 3/4 13 1/2 15 1/4 12 12 1/4

Max 17 1/2 19 1/2 20 1/2 16 1/2 21 16 1/2 18

Min 13 3/4 15 16 1/4 13 1/2 16 3/4 12 13 1/2

Max 17 1/2 19 1/2 20 1/2 16 1/2 21 16 1/2 18

Min 14 1/2 14 1/2 15 1/2 14 3/4 16 1/2 13 13 1/4

Max 17 1/2 19 1/2 21 1/2 18 22 1/2 17 3/4 19 1/4

Min 14 1/2 15 17 14 3/4 18 13 14 1/2

Max 17 1/2 19 1/2 21 1/2 18 22 1/2 17 3/4 19 1/4

Min 11 1/4 12 1/4 13 1/4 11 1/4 13 3/4 10 10 3/4

Max 15 1/4 17 18 1/4 14 1/4 18 3/4 14 1/4 15 3/4

Min 11 1/2 12 1/4 14 11 3/4 15 10 1/4 11 3/4

Max 14 3/4 16 3/4 18 1/2 15 19 1/2 14 3/4 16 1/4

Std

Std

0°

1°

0°

1°

Fix

ed

Fro

nt 70°

80°

Sw

ing

Aw

ay 70°

80°

Fra

me

Typ

e

Fo

otr

est

An

gle

Inset

Footrest Type and Extension

Composite/

AluminumPlatform

Tubular/

Autofold



Page 3

o NC o NC

o NC o NC

o NC o NC

o NC o NC 13.0 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5

o NC o NC X X X X X X X X NA NA NA NA NA NA

o NC o NC NA NA X X X X X X X X NA NA NA NA

o NC o NC NA NA NA X X X X X X X X NA NA NA

NA NA NA NA X X X X X X X X NA NA

NA NA NA NA X X X X X X X X NA NA

See availability matrix. Contact Built 4 Me for Spinergy color options NA NA NA NA X X X X X X X X NA NA

o NA NA NA NA NA X X X X X X X X NA

o NA NA NA NA NA NA X X X X X X X X

o

o

o

o

o

o

o

o

o

o

o

o o

o o

o o

o o

o

o

o

o

o

26" All

Omit Handrim

NA on every rim

25" All but Kik

22" = 489 mm 24" = 540 mm

24 24,25,26

24,25

o

o

22,24

24,25

24" Ultra Lightweight Spoke WheelOnly available w/ silver anodized handrim

Schwalbe Marathon

Kik Mako Black

184RT21E2211

E2212Schwalbe Marathon Plus Evolution

$95.00

184RT22

o 184RT12E2211

E2212

Mountain Tire Only available

on 24" Mountain Rear Wheel

Knobby V-TRAK 24

High Pressure Clincher 22,24,25,26 22,24

Pneumatic

Full Poly Tire 20,22,24 20,22,24

Natural Fits available in 22", 24", and 25". Ultra lightweight wheels available w/

alum ano handrim. Not all handrims available on all wheels

20,22,24 20,22,24,26

o 184HR24Spinergy Flex Rim Available on

24" & 25" Spinergy LX wheel

184HR31 Natural Fit LT- Super Grip

E2218 Kik® Mako Black $95.00

$125.00

o 184RT6E2211

E2212High-Pressure Clincher

o 184RT27E2211

E2212Knobby V-TRAK

184RT2E2211

E2213Pneumatic Airless Insert

$95.00


$80.00

o 184RW25Omit Rear Wheel and Axle

(Intended Size for Set Up ______ )


24" Mountain $250.00













184RW98

184RW99

184RW40

184RW95

184RW96

184RW97

184RW32

17.5"

184RW28

Rear Wheel Type

184RW92

184RW93

184RW3

184RW8

20" Mag Wheel

184RW90

NC

184RW1

184RW78

184RW94

22" Mag Wheel NC

184RW91

24" Mag Wheel NC

184RH37 19.5"184RH17 16.0"

184RH16 15.5"

184RH27 18.5"184RH15 15.0"

184RH21 19.0"

184RH14 14.5"

184RH12 13.5"

184RH13 14.0"

25" Kik

184RH18

17.0"


Rear Seat Height

184RH11 13.0" 16.5"

13" & 13.5" NA w/ transit

o 184RW7722" Ultra Lightweight Spoke WheelOnly available w/ silver anodized handrim

$250.00

184RH19

18.0"184RH20

184RH26

22,24,25,26

Lite Spoke

Wheel/Tire

20" All

Rear Seat to Floor Height Matrix

22" Poly

WheelMag

Ultra

LightweightTire

22" Pneu

24" Pneu

24" All but Pneu

20,22,24 20,22,24,26

Spinergy

$250.0024,25,26

Rear Wheel Tire

o 184RT1E2211

E2212Pneumatic NC

o

184RW50

$95.00

184HR30

o 184HR8

-$55.00

o 184HR7

NC

$525.00

$395.00

$375.00

NC

$240.00

184HR4 Plastic Coated -NA on every rim

184AX1 Quick Release Steel

8 Oblique NA w/ plastic coated

handrims. Only available with 24" or 26 "

Mag or Lite Spoke rims.

Natural Fit - Standard Grip

Handrim


24

24,26Pneumatic w/Airless Insert

24,26

Natural Fit - Super Grip

Natural Fit LT- Standard Grip

$95.00

$395.00

$375.00184HR22

$90.00

Axle

o 184AX11Quad Quick Release

Mag and Mountain Wheel only

184HR23

Note: These values are representative of a 16" seat depth with 1" of seat squeeze and

standard axle plate. Due to variances caused by seat angle, rear seat height ranges may

shift up or down by as much as 1/2". Call customer service or online configurator for more

information.



Page 4

o See Matrix

o o

o

o

o

o

o -14° o -12° o -9° o -7° o -1° o 0° o +4° o +5° o NC o NC

Select desired setting o NC o NC

o NC o NC

o NC o NC

o o NC

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o 9" o 10" o 11" o 12" o 13"

o o

o o

o o

o

NC

184B9 Tall NC

NC

Full Length - Contour (14") NC184AM22

E0973 Single Post Hgt. Adj. Low (7"-11")

Armpad for Height Adjustable

Suggest using classic for tray tables. Contour only available w/ single post

height adjustable

Desk Length - Classic (10")

NC

184AM23

Low NC

Medium

Desk Length - Contour (10")184AA29

184VU8

184VU12

184VU3

184B5

184B1

Backrest

NCOmit Armrest

Purple Heart with Navy Patch $145.00

184AA14

Back Type

184BT10 Standard (9"-20") NC

Purple Heart with Marines Patch $145.00


Coast Guard Patch $90.00


Navy Patch $90.00

17"-21"

17" max height for shipping184UX12 13"

184UX10 12"

NC

184UX4 9"

184UX18 16"184UX8 11"

184UX6 15"

184UX14 14"

184AH1 3" Pivot Point Setting NC

184AH2 4" Pivot Point Setting NC

o 184PH11

Marines Patch $90.00


Military Service Patches (Optional)

Only available on tension adjustable upholstery and J3 Back

184VU1

$25.00

$100.00o 184PH5Fold-Down Push Handles

Only available w/ Adj Upholstery

$260.00 NC

$260.00 184AM21

184AM24 Full Length - Classic (14")

o 184PH12Omit Push Handles w/8° Medium &

Tall only, NA w/ Angle Adj Back

$175.00


184BU8 Tension Adjustable Upholstery

184BT84 Angle Adjustable Back (3" & 4")

Integral Push Handles

Angle Adjustable Back Setting

Push Handles

184PH6

Integral Push Handles w/8°Medium &

Tall only, NA w/ Angle Adj Back

$165.00

5. BACKREST

Price List

10"

184UX20

$145.00

JAY Back (Optional)

184PH2

Back Height Setting

Backrest Upholstery

184BU1 Standard Upholstery NC

Backrest Height Matrix

NC

Omit Push Handles NC

Purple Heart with Army Patch $145.00

184VU11 Purple Heart with Air Force Patch $145.00

$275.00

Height Adjustable

184AA11 E0973 Single Post Hgt. Adj. Std (8.5"-13.5")

184VU13

184VU10

184VU9

Omit ArmrestPadded Swing Away

6. ARMREST

Purple Heart with Coast Guard Patch

184UX16

Flip Back Height Adj LITE (8.5"-13.5")E0973184AA65

Settingo

Some limitations when used w/ angle adj back in the rear most setting

184JB01 J3 Back (See J3 Order Form)

184AA18E0973 Padded Swing-Away STD (9" to 13") $175.00

N/A

Integral

Fold Down

Omit

Integral

Omit

Integral

Omit

Fold Down

Fold Down

An

gle

Ad

justa

ble

(3"

Piv

ot)

An

gle

Ad

justa

ble

(4"

Piv

ot)

Medium

Tall

Medium

Medium

Tall

Low

Medium

Low

17"-20"

N/A

Back

Type

Push

Handles

Backrest

Height

Available

Height Range

Low

Medium

Tall

Fix

ed

Tall

17"-20"

12"-15"

Tall 16"-19"

Medium

Medium

9"-12"

9"-12"

13"-16"

17"-20"

13"-16"

16"-19"

13"-16"

Low

Medium

14"-17"

18"-21"

Tall

Low

Low

Medium

Tall

13"-16"

17"-20"

N/A

14"-17"

18"-21"

N/A

17"-20"



Page 5

o

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o

o

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o

o

o

o

Only available w/ high mount push or pull to lock wheel lockso

o

o

o

o

o

o

o o

o

o

o o

o

o

o o

o

o

To order any JAY cushions on-chair, please see the JAY price list. o

Cushion name or part number must be filled out with desired width and depth o

o

o

o

o

o

o

o o

o o

o o

o

o

o

o

o

Only available w/ Mag, Mountain, and Lite Spoke wheelso

o

Only available w/ high mount push or pull to lock wheel locks on pneumatic orpneumatic w/ airless tire options

Seat Pouch184A8

184A120 K0108 Positioning Belt Slide Clamps $50.00184A118 E0978 Belt 2" Aircraft Buckle Pad w/Clamp $120.00184A117 E0978 Belt 2" Aircraft Buckle w/Clamps $110.00

To inquire about any unique customization for Quickie products, contact: Phone:(800) 333 - 4000, Option #3, Fax: (800) 333 9011

Positioning Belts184A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00 o 184C108

Zebra (Choose above base color) Stdwith White unless above base paint ischosen NA w/ Black

Built for Me

184A994 Gel Cover Swing Away Arm $105.00

184C43 Mossy Oak Camouflage $295.00

Custom Frame Color

NC

184C112 Desert Camouflage $295.00

NC184C103 Rootbeer

184C114


184C6

Candy Purple

Sparkle Silver

Matte Green

184C36 Candy Blue

184C128

NC184C4 Midnight Purple NC184C5 Pearl Pink

NCNC

184AT1 E0971 Rear Anti-Tip $135.00

Matte Black184C126

184C117184C116

NC184C127 Fuchsia NC

Glow

$45.00

NC

Width:

184SG33 K0108 Plastic Standard (8.5" High) $125.00Side Guard

NA w/ padded swing away arms

184C35

$30.00Impact Guard Neoprene $85.00

Miscellaneous

$45.00

Extension Handle (Pair)

Quickie Seat Pouch Black

Additional Cover & Pack Accessories184A500 Gel Cover Hanger/Frame $105.00

$50.00

Omit NC

Ergo Scissor $100.00

High Mount Push NC Quickie Kids Backpack Black184A2

BackpackNo Gos may exist depending on wheel size and position

Do Not Mount NC



Wheel Lock

184WL12



184WL1

184EH7 E0961

Extension Handle


184WL10184WL30 Compact $125.00184WL27

E0974

Seat Sling184SL6 Omit Seat Sling -$15.00

Grade Aid $150.00184GA1

Anti-Tip

Caddy

184SG29 K0108 Plastic Low (6.5" High) $125.00

Transit Option

184IG2

Tool KitExtra Leg Strap Black


$60.00

Spoke Guards

184A54 K0038

184A82

184A83

184C14

Grade Aid

$45.00

Frame Color184C2 Black NC

NC

184C38 Blue Opal NC184C10 Black Opal

NC

Forest Green NC

Candy Red NC

Copper NC

184CU1 E2601 2" Cushion $95.00Cushion

184C11 Toxic Green NC184C113 Titanium Color Paint NC

o 184JC20JAY Bundled Cushion


Depth:

184C8 Yellow NC

$295.00


Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie 2 Lite 108610 REV. K

Page 6



Plastic Coated NC

Rear axle position available 16.5"-17.0". NA w/ Rounded Frame, Transit or HD Options. Higher seat heights may be available through Built 4 Me.

Xtender Power Assist 4X Multiplierw/ Pneumatic Tires - NICKEL $6,595.00

018XT3 E0986 Xtender Power Assist 4X Multiplierw/ Pneumatic Tires - LITHIUM $7,595.00

018XH4 Stainless Steel NC

Xtender Handrim Options018XH3

018XT2 E0986

Spare NiMH Power Pack - NICKEL $1,395.00018XA7 Spare NiMH Power Pack - LITHIUM $1,795.00

Xtender Accessory018XA1

018WM33 K0005 70° Fixed Front Frame NA w/ Kids Frame or 8" Casters $2,150.00

Xtender - Tire Option


018C108

018XW1

2. FRAME STYLE & SET UP

Rear Frame Type (250 lbs. Weight Capacity) Frame Color

Black Opal NC

E2211E2212 Pneumatic

Rear Side Frame Rounded Lowest two axle plate positions NA w/ 20" rear wheels and 8" caster

NCBlue Opal NC

018C36018C38

Candy Blue NC018C14 Candy Purple

018C43

Zebra (Choose above base color) Std with White unless above base paint is chosen NA w/ Black




Matte Green NC

$295.00

Heavy-Duty - 350 lbs. Maximum Weight LimitNA w/ Xtender Power Assist. Package includes: Tri-Cross Brace, Reinforced Back Upholstery, Stabilizer Bar

018HV1

Rear Side Frame Straight NC

Transit SystemNA w/ Padded SA Armrests, Stroller Handles or Xtender Power Assist; Includes Stabilizer Bar

018RS2

018RS1

Pearl Pink NC018C103

K0108 Heavy Duty $500.00

018C5Xtender Power Assist

$315.00018TO1

NC

Transit System

60° Fixed Front Frame



Fax Email

K0005

Quickie 2HPAugust 2013EIHP

$2,150.00

Confirm Via:

1. FRAME STYLE

018WM33

Ship To Phone:

Date: PO#:


Dealer Acct #:

Dealer City:

Dealer Contact:Dealer Address:


Address:

Ship To:Attention:

Dealer Phone: Address:


018C2 Black NC018C10

NC

018C128 Copper NC018C35 Candy Red NC

018C127 Fuchsia NC018C6 Forest Green NC

018C4 Midnight Purple NC

018C126 Glow NC

018C117

Rootbeer NC018C114 Sparkle Silver NC

NC018C11 Toxic Green NC018C113 Titanium Color Paint NC

018C8 Yellow

Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (9.09) Quickie 2HP 930904 REV. AE

Page 1

018JB01 J3 Back (See J3 Order Form) Price List

18" NC018B63018B64 20" NC

018B62

018B65 21" NC

JAY Back (Optional)018SR3 Tall Stroller Handles $125.00

19" NC

018B60 16" NC018B61 17" NC

018B58 14" NC018B59 15" NC

018B56 12" NC018B57 13" NC

Optional Back Height (See Chart for Desired Height)018B9 Tall NC

018B1 Low NC018B5 Medium NC


Back Tube Height (See Chart)018BD1 Back Angle +3° NC

NC018BD4 Back Angle - 12° NC018BD3 Back Angle - 6° NC

$165.00 Angle Adjustable Pivot 5° NC Angle Adjustable Pivot 6° NC

Optional Pre-Set Angle Angle Adjustable Pivot 7° NC

$165.00 Angle Adjustable Pivot 3° NC Angle Adjustable Pivot 4° NC Angle Adjustable Pivot 5° NC

Angle Adjustable Regular Pivot

018BT22 Angle Adjustable Tall Pivot

018BD5

018AH1018AH2

Back Angle - 15°

Stroller HandlesNA w/ push handles when angle adjustable back is selected. NA w/ amputee axle plate, flip back or flip back height adj arms, and Xtender Power Option


018BP2 Omit Push Handle Straight N/A w/HD NC

018BU14 Omit Back Upholstery -$15.00Omit Push Handle 8° N/A w/HD $25.00

018B5 Medium (12"-15.5") NC018B9 Tall (15.5"-19") NC

Low (8.5"-12") NCOPTION 1 - Standard Backrest

018JC20JAY Bundled Cushion

$95.00018CU2 Omit Cushion NC018CU4 Omit Sling -$15.00

018SD11

$75.00

018SD13 E220320" Avail. only on long frame or extra long frame for 19"-20" deep. Extra long frame steel reinforced.

$475.00

018SD72

NC

018FL8Short 70° (10"-11", 13"-16" only)NA w/ HD Package, 26" rear wheels or 17" and 18" sling depths

018FL7Short 60° (10"-11", 13"-16" only) NA w/ HD Package, 26" rear wheels or 17" and 18" sling depths

NC

Backrest Options (Available w/ Option 1 or 2)

018FL22 Long 60° (15"-18" only) NC

Cushion

NC

018CU1 E0669

018SD5

018BT20

4. SEATING

OPTION 2 - Angle Adjustable Backrest (+3° to -15°)

19" Avail. only on long frame or extra long frame for 19"-20" deep. Extra long frame steel reinforced.

Select pivot point, back height and back tube - see chart for optionsNA w/ flip-back or flip-back height adjustable armrests.

2" Cushion

18" 70° short frame or 60° kids frame NA w/ 17" and 18" sling depths Available only on long frame or extra long frame.

NC

12"

14"

018SD3 10" Seat Depth

NCNC

018FL28 X-Long 70° (17"-20" only)

Frame Width

018FL23 Long 70° (15"-18" only)

NC

11" (by upholstery) NC

NC018W3

018W7018W8018W9

018W13 E2201

$450.00

018FL2Kids 60° (10"-14" only) NA w/ HD Package, 26" rear wheels or 17" and 18" sling depths


018W2Frame Length - Contiunued

018W12 E2201

018W10018W11

018W4

E2201

NCNC

15"

12" NC13"

018W5018W6

NCNC

$450.00

16" 17" 18"

22" (Only Avail. w/ Heavy Duty) $450.00

19" (Long or X-Long Frame Only)NC

NC018SD6 13"

20" (Long or X-Long Frame Only)21" (Only Avail. w/ Heavy Duty)

018SD10 17" Available only on long frame or extra long frame for 19"-20" deep . NC

NC018SD9 16" NC

018SD4

Frame Length

018FL12 Regular 60° (13"-17" only) NC

11" NC

018FL13 Regular 70° (13"-17" only) NCNC

018FL27 X-Long 60° (17"-20" only)

018SD67 15"

NC

14"

NC

NC018SD7

Back Type - Choose Option 1 or Option 2

018B1

Price ListCushion Name or Part #:Width: Depth:

018AH3

018AH3018AH4018AH5

JAY Bundled Cushions - Optional

018BP4

To order any JAY cushions on-chair, please see JAY Price List. Cushion name or part number must be filled out with desired width & depth.

Adjustable Upholstery $175.00018BU1 Standard Upholstery NC

$25.00018BP3 Push Handle 8° Med.or Tall only, NA opt. 2

018BU16 Reinforced $30.00018BU8


Page 2


N/A w/ caster pin locks and N/A with +3/4" or 1-1/2" fork stem bolt

5. FOOTREST

018HL4 Omit Heel Loop NCNC

018HL1 E0951

7. CASTERS - WHEELS - AXLES

Footplates

NC018F1 Composite Available on 14"-22" widths

High Mount Only avail. w/ adult and kids angle adj footplates

NC018E5 Long (19"-21 1/2") NC018E2 Medium (16 1/2"-19")

$30.00018HL5

Footrest Extension Tubes018E1 Short (14"-16 1/2") NC

Omit Leg Strap

$55.00

E0973 Flip Back Height Adj (Classic) $275.00

NA w/ kids frame, amputee axle plate, ext. handles, grade aids, highest axle plate position on rounded rear frame, or Xtender Power Assist. NA w/ angle adjustable back rest

$55.00

NC

Axle Plate

018AL2

$175.00

E0973 Height Adjustable Adult $260.00018AM1

081AA9 E0973 Height Adjustable Kids $260.00

Full Length - Contour (14") NC

018AL5 Curved Adjustable


$190.00

K0038

018HL6

018F48 K0040 Platform Flip UpNA w/ short extension tubes

Omit Armrest018AA14 Omit Armrest NC

$85.00

6. ARMREST

018E16 K0037

$35.00Leg Strap

Armrest (Cont)

Footplate OptionsHeel Loop

Armrest

018AA6

018AA16Padded Swing-Away Adult N/A w/ Xtender Power Assist or amputee axle plate.

$175.00E0973Full Length - Contour (14") NCDesk Length - Classic (10") NC

Caster Wheels018CW1 3" Micro NA w HD package NC

018AM2Desk Length - Classic (10") NC

081AA8

018CW5 5" Low Profile Polyurethane NC018CW31 4" Micro Lighted NA w/ HD package $70.00

$85.00

$85.00

018CW33 E2214E2215 6" Pneumatic


$85.00

8" x 2" Pneumatic NA with Kids frame Length

018CW32 8" Polyurethane NA with Kids frame Length NC

$145.00

018CW6 5" Soft Roll (Grey)NA w/ Frog Legs

018CW37 E2214K0108

$75.00

$75.00

018CW35 6" x 1.5" Semi-Pneumatic only avail. for use in bottom fork holes

018CW7 5" x 1.5" Semi-Pneumatic only avail. for use in bottom fork holes

018CW36 E2214E2215

NC

Caster Fork Options

018CF46 Multi Position ForkNA w/ quick release caster stems

NC

018CW21

NC

E2214E2215

8" Pneumatic NA with Kids frame Length

018CW12 Omit Casters

NC

Caster Pin Locks N/A w/8"x2"NA w/ Xtender or Frog Legs

018CS9

NC

8"x2" Fork

Standard Adjustable

018CS5 3/4" Longer Fork Stem Bolt N/A w/ Xtender Power Assist Option

$395.00018CF44 E1015Frog Legs NA w/ 8" casters. NA w/ quick release caster stems or Xtenders Power Assist

1-1/2" Longer Fork Stem Bolt N/A w/ Xtender Power Assist Option

018CS3 K0073 $195.00

018AA5

Impact Guard018IG2 Impact Guard Neoprene

Flip BackNA w/ kids frame, amputee axle plate, ext. handles, grade aids, highest axle plate position on rounded rear frame, or Xtender Power Assist. NA w/ angle adjustable back rest

NC

Amputee Adjustable Lowest 2 axle plate positions NA w/ rounded rear frame, 20" rear wheels with 8" casters

018CF29 NC

018F3 K0040 Aluminum Angle Adj Available on 14"-22" widths

$185.00

018AM1018AM2

018AM1 Desk Length - Classic (10") NC018AM2 Full Length - Contour (14") NC

NC

$225.008" x 2" Pneumatic w/Airless Insert NA with Kids frame Length

E0959

Offset Adjustable NA w/ swing-away or flip-back armrests; height adjustable armrests available at swing-away price

018CW3 4" Low Profile PolyurethaneNA w/ HD package

018AL29

018AL6


Page 3

Contact Built 4 Me for Spinergy Color Options

NA w/ Xtender Power Assist; Only available w/ Mag and Lite Spoke wheels

Side GuardPlastic side guards NA w/ height adj. arms. Side guard interference w/ Padded SA arms at some heights may exist.

018SG3

Small Handrim (NA w/ 20" wheels) NC


NC

NC

-$55.00


NC

24" Mag Wheel NC$200.00

018RR25 Omit Rear Wheel and Axle(Intended Size for Set Up ______ )

24" Spoke Wheel26" Spoke Wheel

018RW25

22" Spoke Wheel

NC

018AT1

Rear Wheel Tire

$125.00


NC

018RT2 E2211E2213 $80.00

018RT3

018RT1 E2211E2212 Pneumatic NC

Pneumatic Airless Insert

E2218 Full Poly 24" Only

$895.00$895.00

$850.00018OA1

N/A w/ caster pin locks and N/A with +3/4" or 1-1/2" fork stem bolt

Rear Anti-Tip

20" Mag Wheel

Rear Wheel Type

018AL16 E0958 One Arm Drive Adj. Axle Plate

NC$200.00

Omit

20" Spoke Wheel

NC

$695.00018RW43 24" Spinergy (559) SPOX Black

018RW11

Ultra Lightweights only available w/ silver anodized aluminum handrim and HP clincher tire.

018RW8

018RW1018RW9

018AX1

018RW88 24" Spinergy (540) LX Black

018RW42 24" Spinergy (540) SPOX Black

018RW4018RW3

$135.00Rear Anti-Tip

$90.00018AX30018AX11 Quad Quick Release

NC

$695.00

018HM2 Left Hand Mount 018HM1

N/A with amputee axle plate,26" rear wheels, or 21" or 22" seat widths, Xtender Power Assist, 11" or 12" frame width, HD package, extra small table, padded SA armrests, and anti-tip. Only available for use in bottom fork holes and mag wheel. Rear seat height will adjust in 1/2" increments. Rear seat height will be 1/4" lower than std

018RW89

Axle

Quick Release Steel NC

Wheel Lock018WL1 High Mount Push NC

High Mount Right Push/Left Pull NCHigh Mount Scissor NA w/ extension handles, grade aides, kids frame, short frame, or highest axle plate position on rear frame

NC

High Mount Pull NC

018SG4 K0108 Plastic Kids $125.00

Omit NC

K0108 Plastic Regular $125.00

$45.00

018A2 Quickie Kids Backpack Black $50.00

Backpack018A1 Quickie Backpack Black $55.00

Positioning Belts018A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00

Crutch Holder

Seat Pouch018A8 Quickie Seat Pouch Black


018A23 K0065

018A120

Projections NA w/ plastic coated handrims or Kik Tires

Belt 2" Aircraft Buckle w/Clamps $110.00Belt 2" Aircraft Buckle Pad w/Clamp $120.00

018A117 E0978

018HR1 Aluminum Anodized

NC22" Mag Wheel

018A118

NC

E0978

018RT21 E2211E2212

$65.00018WL14

018RW78$250.0022" Ultra Lightweight Spoke Wheel

Natural Fits available in 22", 24", and 25". Handrim selection NA w/ Xtender. Ultra lightweight wheels only available w/ alum anodized handrim

018HR4 Plastic Coated $95.00

$95.00

Hand Rim

018RT6

Schwalbe Marathon Plus Evolution

$375.00

018HR23

Omit Hand Rim NC

018HR22

018A31 E0950 Tray Table $250.00

018HR7


K0108 Positioning Belt Slide Clamps

Natural Fit - Standard Grip NA w/ Mountain or Ultra Light Wheels

Tool Kit $45.00

Miscellaneous018A82 Caddy $45.00018A83

8 Oblique

018A49 Black Spoke Guards

Spoke Guards

018RW77

Performance Wheel Type

018WL5

018WL10

Wheelchair Tray Table

018A24 K0065 Clear Spoke Guards $115.00

Extra Leg Strap

24" Spinergy (559) LX Black

Projection Hand Rim

Natural Fit - Super Grip NA w/ Mountain or Ultra Light Wheels

$395.00

$240.00

018WL2

018HR8

Grade Aid

E2207 Crutch Holder (Can only mount on left side w/ Xtender Power Assist Option)

018WL12

018GA1

$50.00

$195.00$115.00

018EH1 E0961 6" Pair $75.00

Do Not Mount NC

Extension Handle

E0974 Grade Aid NA w/ poly, high-pressure clincher tires, or kids length frames

$150.00

Right Hand Mount

018HM2 Left Hand Mount 018HM1 Right Hand Mount

E2211E2212

High-Pressure Clincher N/C w/ Performance

7. CASTERS - WHEELS - AXLES (CONTINUED)

One Arm Drive


Page 4

Back Tube Height LOW MEDIUM TALLPivot Regular set at 3" 12" 13" 14" 15" 16" 17" 17" 18" 19"Pivot Regular set at 4" 13" 14" 15" 16" 17" 18" 18" 19" 20"Pivot Regular set at 5" 14" 15" 16" 17" 18" 19" 19" 20" 21"Pivot Tall set at 5" 14" 15" 16" 17" 18" 19" 19" 20" 21"Pivot Tall set at 6" 15" 16" 17" 18" 19" 20" N/APivot Tall set at 7" 16" 17" 18" 19" 20" 21" N/AAdjustable Pivot Point Preset Measurement from Seat Sling

BUILT FOR METo inquire about any unique customization for Quickie products, contact: Phone: (800) 333 - 4000, Fax: (800) 333 9011

ANGLE ADJUSTABLE BACKREST CHART


Page 5

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( ) Fax: ( )

ST: ZIP:

o o ( ) Fax: ( )

a a

o

K0005 coding still applies for EIZ10 with certain sizes

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o Yellow NC


Dealer City:



Dealer Acct #:

Dealer Address: Attention:


Address:

Dealer Contact: Ship To:

Date: PO#:


Kids Quickie 2 SENovember 2012

EIZ10

Confirm Via:

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.

The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.

Fax Email Ship To Phone:

$250.00


142C8

142SN10 15" $250.00

142SN09 14" NC

142SN08 13" NC

142SN07 12" NC

142SN06 11" NC

142SN05 10" NC

142FL18 Long NC

142WM07 E1236 Kids Quickie 2 SE $1,775.00

Incl. Stabilizer Bar. N/A with padded swing-away armrests or stroller handles.

FRAMES

Standard Frame - 250 lbs. Maximum User Weight

Frame Type

142RS1 Rear Side Straight NC

Transit System


Frame Color

142C2 Black NC


142C38 Blue Opal NC



142C35 Candy Red NC

142C128 Copper NC

142C6 Forest Green NC

142C127 Fuchsia NC

142C126 Glow NC


142C117 Matte Green NC


142C5 Pearl Pink NC

142C103 Root Beer NC


STD

142FL9 Regular NC

142W9 18" $250.00

142W3 12" NC

142C113 Titanium Color Paint NC

NC

142W6 15" $250.00

142W5 14"

$250.00

142W7 16" $250.00

17"

142SN11 16"

142SN12 17"

142SN13

13" NC

$250.00

142W8

18"

NC

Frame Length

Seat Rail Length (Sling Not Included)

142FL1 Kids

$250.00

142W4

o 142W2 11" (By Upholstery)

Frame Width

KIDS QUICKIE 2 SE (with seat rails)


Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. 931164 REV. I

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o 142JC20 Price List

Width: Depth:

To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part

number must be filled out with desired width and depth.

JAY Bundled Cushion

Name / Part #

NC

142AM9 Foam Short NC

142B5 Medium (12" - 15.5")

o

o

o

o

142AA17 Padded Swing -Away KidsNot avail. w/amputee axle plate or transit

STD

NC


Backrest Options

142AM1 Desk Length (10")

142B1 Low (8.5" - 12")

Upholstery

142BU1 Standard STD

NC

142SL16

142BU8

142B9 Tall (15.5" - 19")

Adjustable Upholstery

142AA16 Padded Swing Away AdultNot avail. w/amputee axle plate or transit

NC

142AA19 Padded Swing-Away MediumNot avail. w/amputee axle plate or transit

NC

142AA6 E0973Flip Back Height Adjustable

(Not avail. w/ Kids Frame)$250.00

Omit Sling, Include Rails NC

142CU1 2" Cushion $95.00

NC

NC

NC

NC

ARMRESTS

142AA9 E0973

Seat - Standard With Push Handles

Ht Adj. Kids $260.00

$150.00

142BP2 Omit Upholstery

142PB3 Push Handle 8° (Med or Tall Only) $25.00

142PBP2 Omit Push Handle - Straight NC

Seat

142SL1 Sling STD

SEATING

142AM2 Full Length (14")

142AM10 Foam Long

142AM1 Desk Length (10") NC

142AM2 Full Length (14") NC

142AA8 E0973 Ht/Length Adj. Adult $260.00



142AA14 Omit Armrest NC



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90° Swing Away Hangers (avail. On

12"-16" widths, not avail. w/8"

casters)

$280.00

90° Footboard (Only avail. Up to 16"

Width, and 70° 80° 90° direct mount)$280.00

Adult Angle Adjustable Footplate

(Available on 12" - 16" W)$175.00

Extensions (Optional)

o 1.42E232" Extensions (n/a w/90° hangers &

elevating leg rests)$55.00

o

$40.00

o 142H23

CH

OO

SE

1O

R2

1. Hanger Type (Mount With Extension Tube) 2. Hanger Type (Direct Mount

Hanger

142H1

E0990

142H2 70° Swing-Away Hanger

FOOTRESTS

Choose 1 or 2

142F1 Composite Footplate (12"-16"w) STD

142E1 Short (see matrix for length) NC

NC

K0040Adult Angle Adj. Footplate (12"-16"w) $185.00

o 142F4K0040

Kids Angle Adj. Footplate

o 142F5Aluminum FootplateAvailable w/ ELRs

NC

E0952 Toe Loops

o

o

142E4 Medium (see matrix for length) NC

142E5 Long (see matrix for length)


Locking Angle Adjustable. (Not avail.

Below 15" W - Requires Heel Loops)$190.00

142A110

o 142E16 K0037High Mount NA elevating leg rests.

Only avail. w/ adult or kids angle adj.

footplates.

$185.00

o 142F3

142HL8 K0038 Leg Straps $35.00

o

o

Footrest Options

142HL9 E0951 Heel Loops $50.00

$55.00

142F61 K0040

60° Swing-Away Hanger NC

1424H14 E0990

Elevating Hanger (Only avail. w/ alum.

Footplates or angle adj. Available on 14"-18" frame

widths. N/A w/ locking angle adj. footplates or short

ext. tubes.)

$295.00

STD

Extension Tube (Required for Option 1)

Footplate

142F48K0040

Platform Flip Up Footplate (n/a with

short ext. tubes. Only avail. With 60° 70°

and 70° V)

$190.00

142E15 Long ELR (ELR only) NC

142A54 k0038 Extra Leg Strap $30.00

Impact Guard

o 142IG2Neoprene

(Only avail. With 60° 70° and 70° V)$85.00

Hanger

o 142H770° Swing Away Hangers Front

Mount (Only avail. w/ Kids or Adult Angle Adj. or

90° footboard footplates)

NC

NC

o 142H690° Swing Away Hangers (Only avail. w/

Kids or Adult Angle Adj. or 90° footboard

footplates)

NC




142F62

o 142E24

142E24K0040

$55.00

Footplate Type

o 1.42E23K0040 Kids Angle Adjustable Footplate

(10" - 16" W)$175.00

4" Extensions (n/a w/90° hangers &

elevating leg rests)



Page 3

o 4" Polyurethane

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o 142RT4 Full Polyurethane (avail w/24" Mag only) $50.00

142RZ2 E2213 Pneumatic Airless Insert $80.00

Caster Tire Tube/Insert

Caster Wheels - Continued

CASTERS

Caster Wheels

$65.00

$85.00

142RT3 Full Polyurethane (avail w/Mag only) $50.00

142CW3

NC

142CW5

142RW54 24" Spoke $100.00

142RW1 24" Mag

5" Low Profile Polyurethane NC

142RW75 22" Lite Spoke NC

$85.00

142RW8 22" Mag NC

142RW74 20" Lite Spoke NC

Rear Wheel Type

142RW3 20" Mag NC

Anti-Tip


o 142CW33E2214

E22156" Pneumatic (Requires selection of

Caster Tire Tube/Insert)$75.00

$85.00

142AX30 Omit NC

142CW34 6" Polyurethane STD

142AX11 Quad Quick Release $90.00

$85.00

Axle

142AX1 Quick Release STD

o

142AL6 E0959 Amputee Adjustable

o 142CW32 8" Polyurethane (Not avail. w/ 90° elevating

leg rests or w/kids frame length.)

Axle Plate

AXLE AND WHEELS

NC

142CW21E2214

E2215

8" Pneumatic (Not avail. w/ 90° elevating leg

rests. Not avail. w/kids frame length. Requires

selection of Caster Tire Tube/Insert)

$75.00

Rear Wheel Tire

o 142RT1E2211

E2212Pneumatic (Requires the selection of

Rear Wheel Tire/Insert)

142AL2 Standard Adjustable NC

Rear Wheel Tire Tube/Insert

Requires a selection of Pneumatic

142OM Omit Caster Wheels NC

Requires a selection of 6", 8" or 8"x2" Pneumatic Tire.

142CZ1 Caster Tube (all sizes)

$70.004" Micro Lighted142CW31

o 142CW75" x 1.5" Semi Pneumatic(only avail. for use in bottom fork holes)

142CW6 5" Soft Roll Semi Pneumatic $85.00


$75.00

o 142CW36E2214

E2215

8" x 2" Pneumatic (Not avail. w/ 90°

elevating leg rests. Not avail. w/kids frame length.

Requires selection of Caster Tire Tube/Insert)

$125.00


$20.00

o 142CZ2 K0064Airless Insert

(Only avail. With 8"x2" Pneumatic)$65.00

Caster Options

142CS5 3/4" Longer Fork Stem Bolt NC

142CS10 1-1/2" Longer Fork Stem Bolt NC

142CS3 K0073 Caster Pin Locks $195.00

NC

Hand Rim


o 142RT1E2211

E2212Pneumatic Tube


142HR7 Omit NC

Wheel Lock

142WL1 High Mount Push NC


Extension Handle

142EH1 E0961 6" Pair $75.00

Grade Aid

142GA1 E0974 Grade Aid $150.00

Requires a selection of Rear Wheel Tire/Insert



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142A112 E0978 1" Dual Pull Side Squeeze Pad w /Clmp $85.00

142A32 E0950 Large (Suggested 18"-20") $250.00

Upper Extremity Support Tray

142A29 E0950 X-Small (Suggested 10"-12") $250.00

142SR3 Tall Stroller Handles $125.00

Stroller Handles


Positioning Belt

142A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00

ACCESSORIES

Backpack

142A1 Utility Pack - Black $55.00

Spoke Guard

142A23 K0065 Black

142A2 Kids Black Backpack - Zippie $50.00

Seat Pouch

142A8 Black $45.00

Crutch Holder


Miscellaneous

142A83 Tool Kit $45.00


142A118 K0108 Belt 2" Aircraft Buckle w/Clamps $120.00

$115.00

142A24 K0065 Clear $115.00

142A31 E0950 Medium (Suggested 15"-17") $250.00

142A30 E0950 Small (Suggested 13"-14") $250.00

Side Guard


Not available with height adj. flip back armrests

142SG3 K0108 Plastic Regular $125.00

142A814 E0978 $120.001" Comfort Fit APB5116



Page 5

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( ) Fax: ( )

ST: ZIP:

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a a

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K0005 coding still applies for EIZ10 with certain sizes

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Ship To Phone:



PO#:

Dealer Acct #:

Date:

KIDS QUICKIE 2 SE W/O SEATING

Transit System

Ship To City:

$1,950.00

1. FRAMES

Standard Frame - 250 lbs. Maximum User Weight

Frame Type

142FT54


142WM08 E1238

Confirm Via:



Fax Email

Confirmation Email:

Kids Quickie 2 SE W/O Seating


Kids Quickie 2 SE (Without Seating)

NOVEMBER 2012

EIZ10

Dealer Contact: Ship To:

Dealer Address: Attention:

Cross Brace with Seat Rails NC

Uses Rear Side Frame Depth Adj. & Depth Adj. Back

142C114

Incl. Stabilizer Bar. N/A with Swing-Away Stroller Handles and Extension

with Cross Brace with Seat Rails.

142FT55 Cross Brace w/o Seat Rails NC

Custom Frame Color

Toxic Green

Yellow

NC

Black NC


142C2

142C128

142C35 Candy Red NC

142C127

142C116

142C117

Sparkle Silver NC

142C6

Candy Blue NC

142C38

Forest Green

Fuchsia

Glow

Matte Black

Matte Green

$295.00

142C43 Mossy Oak Camouflage $295.00

Stars & Stripes

142W3 12" NC

142W5

142W7

142W9

14" NC

142W6 15" $250.00

16" $250.00

142W8 17" (Avail. w/Cross Brace w/ Seat Rails Only) $250.00

18" (Avail. w/Cross Brace w/ Seat Rails Only) $250.00

142W4 13" NC

Frame Color - Continued

NC

NCMidnight Purple

11" (By Upholstery)(Avail. w/Cross Brace w/ Seat Rails Only)

o 142W2142C14

142C5

142C126

NC

NC

NC

NC

NC

NC

NC

142C4

Pearl Pink

Copper

Root Beer NC142C103

Titanium Color Paint

Candy Purple

142C113

o 142C108

142C42

Blue Opal

Frame Width

NC

Frame Color

142C36

142C10 Black Opal

NC

NC

NC

142C11

142C8

$295.00Zebra (Choose above base color) Std

with White unless above base paint is

chosen. NA w/ Black

NC



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To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part

number must be filled out with desired width and depth.

Name / Part #

NC142AM10

Foam Short

Foam Long

Width:


o 142JC20

JAY Bundled Cushion

Price List

Depth:

142FD9

142AM2 Full Length (14") NC142AM9 NC

18" Frame Depth NC

NC

10" Frame Depth NC

142FD8 17" Frame Depth NC

142FD 15" Frame Depth NC

142FD4 13" Frame Depth



142FL9 Regular Frame (12"-18" Depth) NC





FRAME DEPTH AND BACK POST LOCATION

Choose 1 or 2

1. Frame Depth and Back Post Location W/O Seat Rail 2. Frame Depth and Back Post Location With Seat Rail

CH

OO

SE

1O

R2

142FL1 Kids Frame (10"-16" Depth) NC

142FD3

142AA7 E0973 Ht/Length Adj. Locking Flip Up $260.00

Long Frame (14"-20" Depth) NC



NC


142AA1 E0973 Ht. Adj. Locking Flip Up $250.00

Frame Length

ARMRESTS

142AA3 Flip Up STD 142AA9 E0973

142FD11

142FL1 Kids STD

142FL9 Regular NC

142FL18 Long NC

Stroller Handle Options

142BP33 Swing Away Stroller Handles $100.00

Seat Rail Length (Sling Not Included)

142BP29 Depth Adj. Back Post Tall NC

20" Frame Depth NC

142FD10 19" Frame Depth

142BP28 Depth Adj. Back Post Medium NC

142SN05 10" NC

142SN06 11" NC

142SN07 12" NC

142SN08 13" NC

142SN09 14" NC

142SN10 15" $250.00

142SN11 16" $250.00

142SN12 17" $250.00

1" Offset From Seat Rail NC

142SN13 18" $250.00

Back Post Location

Stroller Handle (Height)

142BP27 Depth Adj. Back Post Standard STD

DEPTH ADJUSTABLE BACK and JAY

142BL15 2" Offset From Seat Rail NC

142BL14


Ht Adj. Kids $260.00



142AA8 E0973 Ht/Length Adj. Adult $260.00





Page 2

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o 4" Polyurethane

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142CW3

FOOTRESTS

Choose 1 or 2

142F1 Composite Footplate (12"-16"w) STD

142E1 Short (see matrix for length) NC

$185.00

o 142F3K0040

Adult Angle Adj. Footplate (12"-16"w) $185.00

o 142F4 K0040 Kids Angle Adj. Footplate

o

CASTERS

Caster Wheels

Caster Tire Tube/Insert

Caster Wheels - Continued

K0038 Leg Straps $35.00

o

142E24K0040 Adult Angle Adjustable Footplate

(Available on 12" - 16" W)$185.00

142E4 Medium (see matrix for length) NC

142E5 Long (see matrix for length) NC


o 142E16 K0037High Mount NA elevating leg rests.

Only avail. w/ adult or kids angle adj.

footplates.

142F5Aluminum FootplateAvailable w/ ELRs

NC

o

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OO

SE

1O

R2

o

Footrest Options

142HL9 E0951 Heel Loops $50.00

$55.00

142HL8

1. Hanger Type (Mount With Extension Tube) 2. Hanger Type (Direct Mount

Hanger

142H1 60° Swing-Away Hanger STD

Hanger

o 142H7

1424H14 E0990

Elevating Hanger (Only avail. w/ alum.

Footplates or angle adj. Available on 14"-18" frame

widths. N/A w/ locking angle adj. footplates or short

ext. tubes.)

$295.00

Extension Tube (Required for Option 1)

Footplate

142F48K0040

Platform Flip Up Footplate (n/a with

short ext. tubes. Only avail. With 60° 70°

and 70° V)

$190.00

142E15 Long ELR (ELR only) NC

$85.00

142A54 K0038 Extra Leg Strap $30.00

o 142IG2Neoprene

(Only avail. With 60° 70° and 70° V)

70° Swing Away Hangers Front



NC

NC

NC




o 142H670° Swing Away Hangers (Only avail. w/

Kids or Adult Angle Adj. or 90° footboard

footplates)

$55.00

$55.00o 142E24

Footplate Type

o 1.42E23K0040 Kids Angle Adjustable Footplate

(10" - 16" W)$175.00

Impact Guard

$65.00

4" Extensions (n/a w/90° hangers &


Extensions (Optional)

o 1.42E232" Extensions (n/a w/90° hangers &


$85.00


o 142CW33E2214

E22156" Pneumatic (Requires selection of

Caster Tire Tube/Insert)$75.00

$85.00

142CW34 6" Polyurethane STD

o

o 142CW32 8" Polyurethane (Not avail. w/ 90° elevating

leg rests or w/kids frame length.)NC

142CW21E2214

E2215

8" Pneumatic (Not avail. w/ 90° elevating leg

rests. Not avail. w/kids frame length. Requires

selection of Caster Tire Tube/Insert)

$75.00

142OM Omit Caster Wheels NC

Requires a selection of 6", 8" or 8"x2" Pneumatic Tire.

142CZ1 Caster Tube (all sizes) $20.00

$70.004" Micro Lighted142CW31


142CW6 5" Soft Roll Semi Pneumatic $85.00


$75.00

o 142CW36E2214

E2215

8" x 2" Pneumatic (Not avail. w/ 90°

elevating leg rests. Not avail. w/kids frame length.

Requires selection of Caster Tire Tube/Insert)

$125.00


$65.00

Caster Options

142CS5 3/4" Longer Fork Stem Bolt NC

o 142CZ2 K0064Airless Insert

(Only avail. With 8"x2" Pneumatic)

142CS10 1-1/2" Longer Fork Stem Bolt NC

142CS3 K0073 Caster Pin Locks $195.00



Page 3

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$250.00142A32 E0950 Large (Suggested 18"-20")

142A31 E0950

142A30 E0950 $250.00

$250.00Medium (Suggested 15"-17")

$85.001" Dual Pull Side Squeeze Pad w /Clmp

X-Small (Suggested 10"-12") $250.00

Small (Suggested 13"-14")

Upper Extremity Support Tray

Black

142A29 E0950

142A112 E0978

Spoke Guard

142A23 K0065 $115.00

142A24 K0065

142RZ2 E2213 Pneumatic Airless Insert $80.00

Rear Wheel Tire Tube/Insert

142RW54 24" Spoke

142RT29 E2218 Full Polyurethane (avail w/Mag only) $50.00

$100.00

Rear Wheel Type

142RW3 20" Mag NC

142RW75 22" Spoke

142RW1 24" Mag NC

NC

142RW8 22" Mag NC

142RW74 20" Spoke NC

Anti-Tip


Omit NC

142AX11 Quad Quick Release $90.00

$85.00

Axle

142AX1 Quick Release STD

142AL71 E0959 Amputee Adjustable

Axle Plate

AXLE AND WHEELS

Rear Wheel Tire

o 142RT1E2211

E2212Pneumatic (Requires the selection of

Rear Wheel Tire/Insert)$85.00

142AL2 Standard Adjustable NC Requires a selection of Pneumatic

NC

Hand rim


o 142RT1E2211

E2212Pneumatic Tube


142HR7 Omit NC

Wheel Lock



Extension Handle

142EH1 E0961 6" Pair $75.00

Grade Aid

142GA1 E0974 Grade Aid $150.00

Requires a selection of Rear Wheel Tire/Insert

ACCESSORIES

Backpack

142A1 Utility Pack - Black $55.00

Positioning Belt

142A141 E0978 Belt 1.5" Auto Buckle w/Clamps

142A2 Kids Black Backpack - Zippie $50.00

Seat Pouch

142A8 Black $45.00


$70.00


142A118 K0108 Belt 2" Aircraft Buckle w/Clamps $120.00

Clear $115.00

Plastic Regular $125.00

Side Guard


Not available with height adj. flip back armrests

142SG3 K0108

Miscellaneous

142A83 Tool Kit $45.00

Crutch Holder

142A814 E0978 1" Comfort Fit APB5116 $120.00



Page 4



Page 5

o o

ST: ZIP:

( ) Fax: ( )

ST: ZIP:

o o ( ) Fax: ( )

a a

o o

For 14" sizes use E1236 o

o

o

See Seat Height Matrix on page 2 o

o o

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o

Definition Price Option # HCPCS Definition Price

NC

NC196SD10

196SD71

17"

18"

19"

NC

NC

$475.00

196SD9

E2203

196SD11

20"

ADDITIONAL SHIPPING INFORMATION

Dealer Contact:

K0005196WM78

Email Ship To Phone:

Option # HCPCS

Fax

Seat Depth

1. FRAME STYLE & SETUP

Attention:

196SD8 15"

$450.00

NC

16"

Quote Order

Ship To:

PO#:

Frame Width

NC

Quickie QXiNovember 2012

EIF6

Mark For:

196SD7

Confirm Via:

Base Model

196W10

Frame Style

196W6$1,845.00

Quickie QXi, Ultra Lightweight Adjustable Folding Wheelchair

Dealer City:

Confirmation Email:



$315.00

Quickie QXi featuring the Jay ION™ cushion

196SD13

196FS9

196FS30 Hemi Frame

NC

NC

196W5 14" NC

15" NC

196W7 16"

NC196W8 17"

14"

NC

18" NC

19"

NC

E2201 20"

Transit System

Submitting for:

Quickie QXi (265 lbs)

196W9

196W11

Transit

196TO38

Dealer Address:

Date:

Dealer Acct #:

Dealer:

Address:


Ship To City:

Standard Frame


Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. (12.11) QXi January 2012, 118441 REV. D

Page 1

12.5" & 13" only available w/ Alum Angle Adj Footplateo NC o NCo NC o NCo NC o NCo NC o NC 14.5 15.0 12.5 13.0 16.0 17.0 14.0 15.0o NC o NC 15.0 15.5 13.0 13.5 16.5 17.5 14.5 15.5o NC o NC 15.0 15.5 13.0 13.5 16.5 17.5 14.5 15.5o NC o NC 15.0 15.5 13.0 13.5 16.5 17.5 14.5 15.5

o NC N/A N/A N/A N/A 17.0 18.0 15.0 16.0N/A N/A N/A N/A 17.0 18.0 15.0 16.0N/A N/A N/A N/A 19.0 19.0 17.0 17.0

o N/A N/A N/A N/A 18.5 19.0 16.5 17.0

o

o

o 17.5 18.0 15.5 16.0 18.5 19.0 16.5 17.0o 17.5 18.0 15.5 16.0 18.5 19.0 16.5 17.0o 17.5 18.5 15.5 16.5 18.5 19.5 16.5 17.5o 17.5 18.5 15.5 16.5 18.5 19.5 16.5 17.5o 17.5 19.0 15.5 17.0 18.5 N/A 16.5 18.0

17.5 19.0 15.5 17.0 18.5 N/A 16.5 18.019.5 N/A 17.5 18.0 19.5 N/A 17.5 19.0

o 18.5 19.5 16.5 17.5 19.0 N/A 17.0 18.5

o

o

o

o

o

o

Footplate mounts with Extension Tube using clamping hardwareo

o

o

o

See Lower Leg Length Matrix for rangeo

o

o

Heel loop not included, see Footplate Option section belowo

o

AluminumOnly available w/Elevating Legrest

o Adjustable Heel Loopo Gel Cover For Hangers (Pair)

$85.00

18.0"

Seat squeeze and seat depth can affect FSH availability

8 Poly8 x 1.5 Semi Pneu


15.0"

4" Low Profile Polyurethane

19.5"

Caster Wheels196CW3

8" Polyurethane

196CF71

3/4"Standard

Caster Fork

6" NC196CF23

196CF12

196CW5 5" Low Profile Polyurethane

6" Polyurethane5" x 1.5" Semi Pneumatic

NC


60° Swing In/Out Hanger196H145

Front Hangers Lower Leg Length Range Matrix

For 3/4" and 1 1/2" Stem bolt matrix see page 5


13.0" 16.5"STD

14.0"13.5" 17.0"

17.5"STD

NC

NC

NC

NCNC

NC

NC

$110.00

3.5" (standard stem bolt only)


5.25"

1 1/2"

$85.00

NC

4 Low Poly4 x 1.25 Semi Pneu

$55.00

18.5"19.0"

NC

196SH41

16.0"

NC

196SH18196SH20

14.5"

Front Seat Height

12.5"

196SH42

196SH34196SH35196SH40

196SH14196SH15196SH16196SH17

Standard Stem Bolt

HEMICaster3.5" FORK 5 1/4" FORK

HEMI

Front Seat Height Matrix

Footplate


$295.00


196H144

o

Short

$35.00

NC

Omit Hanger & Footplate NC

Medium NC

Extension Tubes

196E1

E0951

NC

Hanger & Footplate Options

NC

$185.00

o

196F1 Composite Footplate

196F5

196F3 K0040 Aluminum Angle Adj. Footplate

5 Low Poly5 x 1.5 Semi Pneu6 Poly6 x 1.5 Semi Pneu8 Poly8 x 1.5 Semi Pneu

Caster

5 Low Poly5 x 1.5 Semi Pneu6 Poly6 x 1.5 Semi Pneu

6" FORK 7" FORKHEMI

4 x 1.25 Semi Pneu4 Low Poly

STDSTD HEMI

NC

196E5 Long196E2

196H139

196CW34

196CF17

196CS5

196HL121968A02

196CW35

196CW39

196H141

196CS9

Caster Stem Bolt196CS1

$85.00196CW32

7"

196H143 E0990 Elevating Legrest (Front Latch)All ELR's will be Black paint

196SH2115.5"196SH23

196CW7


196SH12196SH13

See Front Seat Height Matrix. 12.5 & 13.0 only available w/ 60 ° hanger

Composite Alum Angle Adj AluminumShort 11.25" - 14.75" 9.25" - 13.25" NA

Medium 11.25" - 16.00" 9.25" - 14.75" NALong 12.50" - 16.00" 10.75" - 16.25" NAShort 12.00" - 15.75" 10.00" - 14.50" NA

Medium 12.00" - 16.50" 10.75" - 16.50" NALong 13.75" - 16.50" 12.25" - 16.50" NAShort 10.50" - 15.25" 10.50" - 15.25" NA

Medium 11.75" - 16.50" 11.75" - 16.50" NALong 13.50" - 16.50" 11.75" - 16.50" NAShort 11.25" - 15.50" 11.00" - 14.50" 11.50" - 16.50"

Medium 12.50" - 16.50" 11.25" - 16.25" 13.50" - 16.50"Long 14.50" - 16.50" 13.00" - 16.50" 15.25" - 16.50"

ELR values based on 70° hanger angle

70°

80°

ELR

All values are ± 0.25" and based on flat seat heights and do notaccount for the minimum 2" ground clearance or footplate thickness. Full

Hanger Ext Tube Footplate

60°

Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. (12.11) QXi January 2012, 118441 REV. D

Page 2

See Rear Tire & Wheel Matrix for availability

o

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o

See Rear Seat Height Matrix o

o

o

o See Rear Tire & Wheel Matrix for availability

o

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o

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o

o

o Natural Fit only available w/ 22, 24, 25 Lite Spoke. Plastic NA w/ 25, 26"

o o

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o

o

o

o

o

Ext. handles only available with high mount push or pull wheel locks

o

o

Some limitations when used with the Angle Adjustable Back in the rear most setting o

Please circle a setting, will default to 11" if no selection is made o

o 9" o 10" o 11" o 12" o 13"

o

o

o

o

o

o

196RW8

NC

$375.00Natural Fit - Standard Grip

NC

Natural Fit - Super Grip

NC

High Mount Pull

Hemi Frame

12.0" - 15.0"

$80.00


Pneumatic w/ Airless Insert

12.5" - 16.0"

Full Length - Full (14") NC

Gel Cover For Swing Away Arms (pair)

Desk Length (10")

$110.00

E2211

E2213o 196RT2

196EH7

Extension Handle

NC

NC

$175.00

o

Rear Wheel Tire

Rear Wheel Size

$60.00

Quick Release Steel

NC196RT1E2211

E2212Pneumatic

Omit Wheel Lock

Do Not Mount

196WL10

196WL12

Compact

NC

15.0" - 18.5"

NC

Std Frame

20" Rear Wheel 13.0" - 16.5"

22" Rear Wheel 14.0" - 17.5"

14.0" - 17.5"

12.5" NC

196RH12 13.5"

14.5"

196RH13 14"

196RH14

196HR22

1968A01

$90.00Quad Quick Release Steel

NA on Spoke

5. ARMREST

oHigh Pressure Clincher N/A

E0973

Axle

NC

Extension Handle (Pair)

196AX11

196AX1

High Mount Push

196WL2

196AM23

Pneumatic

20,22,24,26 20,22,24,26

20,22,24,26

22" = 489 mm 24" = 540 mm

Rear Tire & Wheel Matrix

Armrest - Padded Swing Away

oSetting

Padded Swing-Away STD (9" to 13")196AA18

Pneumatic w/ Airless Insert

Full Poly Tire 20,22,24 20,22,24

E0961

NC

NC

NC

NC

NC

18"

Handrim

196HR1

196HR4

Aluminum Anodized NC

Plastic $95.00

196WL1

NC

196HR23

Armrest Options

$395.00

196WL30

Wheel Lock

$125.00

22,24,25,26

Armpad - For Height Adjustable

196AA14 Omit Armrest

18.5"

196RH17 16"

17.5"

196RH20

196RH19 17"

E0973196AA65

196RH27

196RH21

196AA104 E0973

NC15.5"

16.5" NC

NC

15"

NC

NC

196RH16

20,22,24,26

Seat Squeeze Matrix

19"

196RH18

NC

196AM24

Mag SpokeTire

196RH15

Single Post Ht. Adj - Std (9.75"-14.75") $260.00

Flip Back Ht Adj LITE (10"-15") $275.00

Wheel

$260.00

Armrest - Height Adjustable

196AA105

196RH26

E0973 Single Post Ht Adj - Low (8.25"-12.25")


12"

26" Rear Wheel

24" Rear Wheel

14.5" - 18.0"

13.5" - 17.0"


196RW91 22" Lite Spoke Wheel $200.00

196RW92

196RW3

Rear Seat Height Matrix

Rear Wheel Size


196RW1 24" Mag Wheel NC

196RW90

22" Mag Wheel NC

NC20" Mag Wheel


196RW25

196RW100 25" Lite Spoke Wheel $200.00

196RH9

$95.00

196RH10

Omit NC

196RW101

25" Rear Wheel 15.5" - 19.0"

NC

196RH11 13"

196RT6E2211

E2212High-Pressure Clinchero

Rear Seat Height

16.0" - 19.5"

196AA103 E0973 Dual Post Flip Back Ht Adj $275.00

Frame Depth Max Seat Squeeze

14" 2.0"

15" - 16" 2.5"

17" - 18" 2.5"

19" - 20" 3.0"



Page 3

o o

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Only available on tension adjustable upholstery and Jay 3 Back

o

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o

o

Cushion name or part number must be filled out with desired width and depth

o o

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o

Black Opal NC

196C38 Blue Opal NC

196C10

Anti Tips

1964A01

Spoke Guards

$135.00Anti Tips (Pair)

Caddy

E0971196AT1

US Army Patch $90.00

Side Guards

196SG33 K0108 Plastic - Standard (8.5" High) $125.00

196VU1 US Marines Patch $90.00

196VU2

US Air Force Patch $90.00

196VU3 US Navy Patch $90.00

196VU4

$90.00

196VU12 US Coast Guard $90.00

196VU10 Purple Heart with Navy Patch

196VU8 Purple Heart with Marines Patch

196VU5 Purple Heart

NC

Back Upholstery

196BU1 Standard Upholstery

Integral Push Handles

8° for Std Backrest, Straight for

Angle Adj. Backrest

NC

o 196BU70

$100.00

o 196PH2

Omit Push Handles

8 ° for Std Backrest, Straight for

Angle Adj. Backrest

NC

o 196PH5

Fold-Down Push HandlesOnly available with Adjustable Upholstery.

Used in combination w/Angle Adjust only

avail in 16"-20"

196B5 Med (13"-17") NC

196B9 Tall (16"-20") NC

Backrest HeightE2611 $330.00

E2611Backrest Tension Adj Ballistic Nylon

*Reference 186BU70 for billing$315.00

196BT100 Angle Adjustable Back $165.00

196A2100 E2207

196VU13

6. BACKREST

K0108

Purple Heart with Coast Guard

$70.00

$45.00

Pack Accessories

196A1 Backpack - Black/Charcoal Adult $55.00

1961A01

196A141 E0978

196A804 K0108 Positioning Belt Slide Clamps $50.00

1.5" Auto Buckle w/ Clamps

196C36

$125.00

7. SEATING

196SG29

NC

NC

NC


o 196JC20

JAY Bundled Cushion

Price List

Candy Blue

Candy Red

$145.00

Depth:

To order any JAY cushions on-chair, please see the JAY price list.

$195.00Plastic - Low (6.5" High)

8. Key Options & Accessories

Seat Pouch Black

1968A03

Miscellaneous

Quickie Black Spoke GuardK0065 $115.00

$45.00

NC

Seat Sling

Cushion Name or Part #

196SL6 Omit Seat Sling -$15.00

Width:

Black

196VU11 Purple Heart with Air Force Patch $145.00

JAY J3 Back See OF

Military Service Patches

$145.00

196VU9 Purple Heart with Army Patch $145.00

JAY J3 Back

196JB01

Backrest Tension Adj 3DX Vented

*Reference 186BU71 for billing

196BU14

196BU71o

-$15.00Omit Back Upholstery

$145.00

Back Type

196BT10 Standard NC

196SL23 Seat Sling Depth Adjustable

Push Handles

o 196PH6

Crutch Holder

Frame Color

196C2

196C35

Positioning Belt



Page 4

N/A N/A N/A N/A 17.0 18.0 15.0 16.0 N/A N/A N/A N/A 17.5 18.5 15.5 16.5






N/A N/A N/A N/A 19.5 19.5 17.5 17.5 N/A N/A N/A N/A N/A N/A 18.5 18.5


18.0 18.5 16.0 16.5 19.0 19.5 17.0 17.5 19.0 19.5 17.0 17.5 N/A N/A 18.0 18.5

18.0 18.5 16.0 16.5 19.0 19.5 17.0 17.5 19.0 19.5 17.0 17.5 N/A N/A 17.5 18.5

18.0 19.0 16.0 17.0 19.0 19.5 17.0 18.0 18.5 19.5 16.5 17.5 19.5 19.5 17.5 18.5

18.0 19.0 16.0 17.0 19.0 19.5 17.0 18.0 19.0 19.5 17.0 18.0 N/A N/A 18.0 19.0

18.0 19.5 16.0 17.5 19.0 19.5 17.0 18.5 18.5 19.5 16.5 18.0 19.5 19.5 17.5 19.0

18.0 19.5 16.0 17.5 19.0 19.5 17.0 18.5 18.5 19.5 16.5 18.0 19.5 19.5 17.5 19.0

N/A N/A 18.0 18.5 19.5 19.5 18.0 19.5 N/A N/A 18.5 19.0 N/A N/A 18.5 19.5

19.0 19.5 17.0 18.0 19.5 19.5 17.5 19.0 N/A N/A 18.0 19.0 N/A N/A 18.5 19.5

Caster

8 x 1.5 Semi Pneu

HEMI

4 Low Poly

4 x 1.25 Semi Pneu

5 Low Poly

1 1/2" STEM

STD HEMI STD HEMI

4 Low Poly

4 x 1.25 Semi Pneu

3/4" STEM

Caster3.5" FORK 5 1/4" FORK

5 Low Poly

5 x 1.5 Semi Pneu

6 Poly

STD HEMI

6 x 1.5 Semi Pneu

8 Poly

8 x 1.5 Semi Pneu

7" FORK

5 Low Poly

5 x 1.5 Semi Pneu

Caster6" FORK

STD HEMI

Caster3.5" FORK 5 1/4" FORK

STD HEMI STD

6 Poly

6 x 1.5 Semi Pneu

8 Poly


6 Poly

6 x 1.5 Semi Pneu

8 Poly

8 x 1.5 Semi Pneu

4 Low Poly

4 x 1.25 Semi Pneu

8 x 1.5 Semi Pneu

4 Low Poly

4 x 1.25 Semi Pneu

5 Low Poly

5 x 1.5 Semi Pneu

6 Poly

6 x 1.5 Semi Pneu

8 Poly

7" FORK

STD HEMI STD HEMI

6" FORK

5 x 1.5 Semi Pneu


Front Seat Height Matrix Cont.



Page 5

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ST: ZIP:

( ) Fax: ( )

ST: ZIP:

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a a

12"-14" NA w/ 8" casters or 24" wheels

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Rear STFH ranges from 0" to 1 1/2" lower than front STFH

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o 20.5" (Only available on swing away)


065WM30 K0004

Transit Option

Transit System $315.00

Quickie LX (Non Adjustable Axle Plate)

250 lbs Weight Capacity$1,755.00K0005

Quickie LXI (Adjustable Axle Plate)

265 lbs Weight Capacity$1,845.00 o

Includes stabilizer bar. Only on LXI. NA w/ padded swing away armrest

065TO1

065SH26 NC

065SH24 20" NC

065SH23 19.5" NC

065SH21 19" NC

065SH20 18.5" NC

065SH18 18" NC

065SH17 17.5" NC

065SH16 17" NC

065SH15 16.5" NC

065SH14 16" NC

065SH13 15.5" NC

Front Seat Height


$125.00

065SD70 18" NC

065SD74

Confirm Via: Ship To Phone:

065SH12 15" NC



Dealer Acct #:

Date: PO#:

Ship To:

Attention:

Address:


Quickie LXI/LXNovember 2012EILXI/EILX

o 065WM31

Dealer Phone:

Dealer Contact:

Dealer Address:

Confirmation Email:

1. FRAME STYLE



Fax Email

Ship To City:

$475.00

19"

065SD13 E2203 20"

065SD69 17" NC

15" NC

065SD9 16" NC

NC

065SD7 14" NC

20"

16"

17"

18"

19"

15"

12" NC

13"065W4

065W5

E2201

065W6

065W7

065W8

065W9

065W41

065W11

Seat Depth

065SD5

NC

NC

065SD67

12"

13"

NC

NC

NC

$450.00

2. FRAME SET UP

NC

$125.00

NC

Frame Width

065W3

14"

065SD6


Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) LXI 930922 REV. W

Page 1

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Contact Built 4 Me for Spinergy Color Options o

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Seat Sling to Top of Footrest

Rear Wheel Type (Cont)

Omit Heel Loop NC

065HL5 K0038 Leg Strap $35.00

o 065F48 K0040Aluminum Angle Adj Kids

NA w/ ELR. Only on 12:-16" wide$185.00

065HL6 Omit Leg Strap NC

065HL4

065F5 Aluminum Footplate NC

065F3 K0040 Aluminum Angle Adj Adult $185.00

Footplate Options (Ext Tube & Direct Mount)

065HL1 E0951 Heel Loop $30.00


o 065F48 K0040Platform Flip UpAvailable w/ 60°, 70°, or hemi hangers

$190.00

065E15 Long ELR NC

Articulating Hanger (15"-20"w)NA w/ Push To Lock Wheel Locks

Footplates

o 065F1Composite (14"-20"w) Only available w/

60 °, 70 °, and ALRNC

Omit Caster Wheel

8" x 2" Pneumatic

E2214

E22158" Pneumatic

065CW37

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o 065CW21

065CW38

E2214

K0108

065CW16

065CS3 K0073

065A500 Velcro Gel Cover for Hanger/Frame $105.00

Elevating Hanger (14"-20"w)Pull to lock wheel locks suggested. Only

available w/alum and angle adj footplates

$295.00

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065H24 K0053

065CW3

o 065CW33

$350.00

065H14 E0990

065H32 Omit Hanger -$15.00

Extension Tube

065E2 Medium (See Matrix for Length) NC

o 065E1Short (See Matrix for Lengths)

NA w/ 90° hangers and ELRNC

o 065E5Long (See Matrix for Length)

NA w/ 90o hangers and ELRNC

o 065E16 K0037

High Mount Only avlailable with

angle adj footplates or 60° and 70°

hangers

$55.00

065E14 Regular ELR NC


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Front mount hangers only available w/ aluminum angle adj footplates

065H86

NC065H85

065CW34

8" x 2" Pneumatic w/Airless Insert


065CW36E2214

E2215

E2214

E2215

NC

$75.00

4" Low Profile Polyurethane

6" Pneumatic

$85.00

$70.00

6" Polyurethane NC

Caster Pin Locks (N/A w/8"x2") $195.00

$160.00

$85.00

$145.00

$85.00

$75.00

NC

NC

$225.00

7" Polyurethane



5" Soft Roll (Grey)

NA w/ Frog Legs$85.00


065CW7 5" x 1.5" Semi-Pneumatic







Hangers

Caster Wheels

065CW31

o 065CW54


4" Micro Lighted

3. FRONT SEAT HEIGHT SET UP (CONT)

065CW35

Caster Wheels (Cont)


Caster Options


Rear Wheel Type

065RW2

065RW3

065RW8

065RW1

065RW99

065RW50

065RW95

065RW96

065RW97

24" Mag Wheel NC 065RW98

065RW11

065RW4

065RW9

20" Mag Wheel NC

22" Mag Wheel NC










-$55.00

24" Mountain $250.00

o 065RW25Omit Rear Wheel and Axle

(Intended Size for Set Up ______ )


NCo 065H9190° Swing In/Out HangerNA w/ 8" casters. Pull to lock wheel locks

suggested

*All adjustment ranges may vary due to seat height

restrictions. Recommended 21/2" footrest clearance

to ground surface.

70° Platform Flip-Up Medium Ext. 153/4 - 181/2

70° Platform Flip-Up Long Ext. 173/4 - 201/2

70° Swing- Away Long Ext. 161/2 - 201/4

70° Platform Flip-Up Short Ext. 111/8 - 147/8

70° Swing- Away Short Ext. 111/2 - 151/4

70° Swing- Away Medium Ext. 14 - 173/4

60° Platform Flip-Up Medium Ext. 14 - 18

60° Platform Flip-Up Long Ext. 161/2 - 201/2

60° Swing- Away Long Ext. 161/2 - 201/4

60° Platform Flip-Up Short Ext. 111/2 - 157/8

60° Swing- Away Short Ext. 111/2 -151/4

60° Swing- Away Medium Ext. 14 - 173/4



Page 2

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Only available w/ Mag Wheels

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o Right Hand Mount

o Left Hand Mount

To order Angle Adj Back, please complete next section o

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$175.00


065BU60

065SZ1 Stabilizer Bar $105.00

065BU16 $30.00

Angle Adjustable Tall Pivot

Std w/ Push Handles. NA w/ All Flip

Back Armrests

$165.00

NC

Backrest Options

o

$165.00

o 065BT22

o 065BT20

Angle Adjustable Regular Pivot

Std w/ Push Handles. NA w/ All Flip

Back Armrests

065B63 19" NC

065B60 16" NC

NC

13" NC

Optional Back Height

065B58 14"

065B56

065B57

NC

065B5

065B9 Tall

Medium

NC

065B1

NC

Back Angle +3°

Low

Angle Adjustable Pivot 7°

NC

Back Tube Height (See Chart)


065BD5

065BD1

Angle Adjustable Pivot 5° NC

065B62 18"

065B65 21"

Optional Pre-Set Angle

5. REAR SEAT HEIGHT SET UP (CONT)

Natural Fits available in 22", 24", and 25".

JAY Back (Optional)

065JB01 J3 Back (See J3 Order Form) Price List

NC

065B64 20" NC

065B61 17" NC

065B59 15" NC

Back Angle - 15° NC


065AH2 Angle Adjustable Pivot 4° NC

065AH5

065AH3

Backrest Upholstery

065BU1 Standard Upholstery NC

Push Handles

065BP1 Push Handles Straight NC


065BD3

12" NC

Back Angle - 6° NC

065AH3

065AH4

$185.00

Angle Adjustable Backrest Set Up

6. BACKREST

Back Type

065BU1 Standard NC

Back Height

$25.00

NC

Axle

Quick Release Steel NC

One Arm Drive

065AX3

NC

$850.00

14"-17" $50.00

Tension Adjustable Upholstery

Push Handles 8° (Std)

16"-19"

065B86NC


Angle Adjustable Pivot 6°

Reinforced Back

Only available w/ Std Upholstery

065AX13 Quad Quick Release

24,25,26

20,22,24,25,26

24,25

24,25,26 065HM1

Angle Adjustable Backrest

065AX19 Threaded$95.00

Lite SpokeUltra

Lightweight

Pneumatic 20,22,24 20,22,24,25, 26

065HR7 Omit Hand Rims NC

065HR88 Oblique Only available w/

aluminum handrims. NA w/ Kik$240.00

$80.00


065RT2E2211

E2213Pneumatic Airless Insert

$95.00o 065RT6E2211

E2212High-Pressure Clincher

$125.00


065RT21E2211

E2212Schwalbe Marathon Plus Evolution

Handrim


065HR4 Plastic Coated -NA on all rims $95.00

065HR22 Natural Fit - Standard Grip $375.00

065HR23 Natural Fit - Super Grip $395.00

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065AH1

22,24

22,24

22" = 489 mm 24" = 540 mm 25" = 559 mm 26" = 590 mm

24,25,26

Kik Mako Black

SpinergyTire

24,25,26

Full Poly Tire 20,22,24 20,22,24 24

Pneumatic w/Airless Insert 20,22,24

22,24,25,26

WheelMag

NC

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24,25

o 065RT12E2211

E2212

o

High Pressure Clincher

065AL16 E0958 One Arm Drive Adj. Axle Plate

Mountain Tire Only available

on 24" Mountain Rear Wheel

Rear Wheel Tire

o 065RT1E2211

E2212Pneumatic


Schwalbe Marathon 24 24,25,26

NC

065HM2

065BP3

065B92

NC

NC

A

B

PSIS

SEATING SURFACECUSHIONTHICKNESS

TO DETERMINE THE PROPER PIVOT-POINT HEIGHT,MEASURE BETWEEN THE PSIS AND THE TOP OF THESEATING SURFACE (A), THEN ADD THE THIICKNESS OFTHE CUSHION (B) IF ONE IS USED. IF A DROP-SEAT FALLSBELOWTHE SEAT RAILS, SUBTRACT THIS DISTANCEFROM THE OVERALLVALUE.

REGULAR3”– 5”

TALL5”– 7”

3°15°

REFER TO CHART INDETERMINING PUSH

HANDLE LENGTH



Page 3

o NA w/ padded swing away armrests

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To order any JAY cushions on-chair, please see the JAY price list. o

Cushion name or part number must be filled out with desired width and depth o

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065AA5 Flip-Back NC

065AA6 E0973 Flip-Back Height Adjustable $275.00

065AA8

065AA9 Single Post Ht. Adjustable Low $260.00

065AA17 E0973 Padded Swing-Away Kids $175.00

o 065GA1 E0974Grade Aid NA w/ poly, high-pressure

clincher tires$150.00

Extension Handle

065EH1 E0961 6" Pair $75.00

Anti-Tip

065AT4 E0971 Rear Anti-Tip

065A29 E0950 Tray Table $250.00

065C108o

065A13 E0978

065C113

$295.00

065C43

065C8 Yellow NC


Belt 2" Aircraft Buckle Pad $120.00

Built for Me


Custom Frame Color

065C112 Desert Camouflage

To inquire about any unique customization for Quickie products, contact: Phone:

(800) 333 - 4000, Fax: (800) 333 9011


Zebra (Choose above base color) Std

with White unless above base paint is

chosen NA w/ Black

$295.00


Titanium Color Paint NC


065C103 Rootbeer NC

065C5 Pearl Pink NC


065C126 Glow NC

Forest Green NC

065C127 Fuchsia NC

Candy Red NC

065C128 Copper NC


065C38 Blue Opal NC


065C2 Black NC

065A83 Tool Kit $45.00

065IG2 Impact Guard Neoprene $85.00


$45.00


065A82 Caddy



Belt 1.5" Auto Buckle $70.00

065A12 E0978 Belt 2" Aircraft Buckle $110.00

Quickie Kids Backpack Black $50.00

065A8 Quickie Seat Pouch Black $45.00

065A2

Accessories


Do Not Mount NC

065SG3 K0108

Frame Color

Plastic Regular $125.00

065WL10 Omit NC


065WL30 Compact $125.00


Wheel Lock

Additional no gos may exist depending on wheel size, seat depth and axle

position


Positioning Belts and Side Guards

065A141 E0978

Grade Aid

065WL12

065AM24


E0973

065AA16

NC

Armpad

065AM1 Desk Length - (10") NC

E0973 Padded Swing-Away Adult $175.00

7. ARMREST

Armrest

E0973 Single Post Ht. Adjustable Std $260.00 Full Length - (14")

Purple Heart with Air Force Patch $145.00

065VU10 Purple Heart with Navy Patch

065VU11

$145.00

065VU13 Purple Heart with Coast Guard Patch $145.00

065VU9 Purple Heart with Army Patch $145.00

065VU8 Purple Heart with Marines Patch $145.00


065VU12 Coast Guard Patch $90.00


065VU3 Navy Patch $90.00


Military Service Patches (Optional)

Only available on tension adjustable upholstery and J3 Back

065VU1 Marines Patch $90.00

NC65C117


065JC20

JAY Bundled Cushion


Width:

Matte GreenJAY Cushions (Optional)

o

065C14

$135.00

Depth:

065C35

065C6

Candy Purple NC



Page 4



Mark For: Submitting for:


Attention:

PO#:

Quote Order

Quickie M6™

June 2013EIF1

Dealer City:Address:

Dealer:

Dealer Phone:

Dealer Contact:


Seat Height

115SD33 E2204 22" (Long frame only) $795.00

115HT11 NCNC

Cushion115CU31 E2602 2" Cushion

Frame Length

1. FRAME STYLE & SETUP

Date:

Option # HCPCS Definition

Ship To:

Email

Dealer Acct #:ADDITIONAL SHIPPING INFORMATION

Dealer Address:Address:

Ship To Phone:

PriceOption #

Confirm Via: Fax


Price HCPCS Definition

18.5" Only available w/ 5" casters115HT14 20"

115HT65 17" Includes low adjustable axle plate and shorter fork. Only available with 5" caster

$300.00

$2,895.00Base Model

Quickie M6K0007115WM21 115FL9 Regular (18"-19" depth) NC115FL18 Long (20"-22" depth)

Seat Depth115SD11 18" NC

$475.00115SD12 19" NC115SD13 E2203 20" (Long frame only)

$475.00115SD14 E2203 21" (Long frame only)

$120.00

$245.00

Armrest115AA33 E0973 Dual Post Height Adj - Desk 10" $245.00115AA34 Dual Post Height Adj - Full 14"

115B98 20-1/8" NC115B39 19" NC

16-3/4" NC115B96 17-7/8" NC

$295.00

Backrest

Back Height Preset

115BT34 8° w/ Push Handles Adjustable (16-3/4" to 20-1/8") NC

115B91

115C108Zebra Choose above base color. Std w/ white unless above base paint is chosen. NA with Black.

115C42 Stars & Stripes $295.00115C43 Mossy Oak Camouflage $295.00


115C8 Yellow NC115C11 Toxic Green NC115C113 Titanium Color Paint NC115C114 Sparkle Silver NC115C103 Rootbeer NC

115C5 Pearl Pink NC115C4 Midnight Purple NC

115C126 Glow NC115C127 Fuchsia NC

115C6 Forest Green NC115C128 Copper NC

Candy Blue NC

115C35 Candy Red NC

Black NCBlack Opal NCBlue Opal NC

115W17 K0108

Frame Color115C2

115C10115C38115C36

E2201 22" $450.00115W14 E2202

E0973

28" $475.0026" $475.00

30" $475.00

NC

24" $450.00115W15 E2202

Frame Width115W13

115W16 K0108

115C116 Matte Black NC115C117 Matte Green NC

ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. (9.09) Quickie M6, 932042 REV. Q

Page 1

Option # HCPCS Definition PriceOption #Price HCPCS Definition



Footplates

115F25 K0040 Adult Angle Adj $185.00115F1 Composite NC

4. ACCESSORIES

Positioning Belt

Extension Handle115EH1 E0961 6" Pair $75.00

Axle115AX1 Quick Release NC

115WL10

NC115AL28 Low (only for 17" Seat Ht.) NC

115HR7 Omit Handrim NC

$80.00

Handrim115HR1 Aluminum Anodized NC115HR4 Plastic Coated $95.00

115RT2 E2211E2213 Pneumatic Airless Insert Tire

Rear Wheel Tire

115RT1 E2211E2212 Pneumatic Tire NC


Wheel Rim/Size115RW2 24" Spoke Wheel NC

Adjustable Axle Plate115AL2 Standard (for 18.5", 20" Seat Ht.)

115F5 Aluminum NC

$595.00

NCNCNC

Medium (15.5"-18")115E5

Lower Leg Length Range Matrix

$145.00

115E1

115H41 ELR - Heavy-Duty ReinforcedOnly available with aluminum footplates

E0990

115H13280° Heavy-Duty Ft. Mount Lift OffOnly available with 5" caster and ang adj footplates. NA w/ extension tubes

$95.00

Long (18"-20.5") NA w/ 5" caster

$95.00

Short (13"-15.5")115E2

Seat Height Matrix

Front Hangers115H1 60° Swing Away NC

115H14670° Heavy-Duty Ft. Mount Lift OffOnly available with 5" caster and ang adj footplates. NA w/ extension tubes

Miscellaneous115A83 Tool Kit $45.00

115A142 E0978 Belt 1.5" Auto Buckle $70.00115A13 E0978 Belt 2" Aircraft Buckle Padded $120.00115A12 E0978 Belt 2" Aircraft Buckle $110.00

Omit Wheel Lock NC115WL12 Do Not Mount Wheel Lock NC

Wheel Lock115WL1 High Mount Push Wheel Lock NC

$135.00115AT3 Omit Rear Anti-Tip NC

$225.00K0108E2214

115CW37

115CW36 8" x 2" Pneumatic E2215

8" x 2" Pneumatic w/Airless Insert

E2214

Extension TubesCasters115CW6 5" Soft Roll $85.00


Depth:

Footplate Options115HL1 E0951 Heel Loop $30.00

Rear Anti-Tip115AT1 E0971 Rear Anti-Tip


115JC20JAY Bundled Cushion

Price ListCushion Name or Part #Width:

Composite Alum Angle Adj AluminumShort 11.50" - 13.25" 11.75" - 14.00" 11.25" - 13.50"

Medium 13.75" - 16.00" 14.00" - 16.25" 13.50" - 14.00"Long 16.00" - 16.50" 16.00" - 17.75" NA

70° No Ext Tube NA 9.75" - 13.50" NA80° No Ext Tube NA 10.75" - 14.75" NA

Short NA NA 13.00" - 17.00"Medium NA NA 14.25" - 17.00"

ELR

All values are ± 0.25" and based on flat seat heights and do not account for the minimum 2" ground clearance or footplate thickness. Full range not available with all seat heights. ELR values based on 70° hanger angle

Hanger Ext TubeFootplate

60°

Caster Front/Rear 5" 17" (Different Axle & Fork) 5" 18.5"8" 20"

ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.comSpecifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. (9.09) Quickie M6, 932042 REV. Q

Page 2

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