Ottobock - Start Junior - Order Form

Start Junior
Pediatric manual wheelchair
Date:
Account Number:
Bill to:
Contact Name:
Street Address:
City:
Province:
Postal Code:
Phone:
Fax:
Email:
P.O. Number:
Features:
• Aluminum frame
• Tip-assist (integrated in the frame)
• Individual footrests, angle adjustable, plastic footplate
• Adjustable seat depth 12", 13", 15"
• Rear wheels with quick-release axle
• Standard wheel lock
• Yellow or Red frame colour
• Black nylon seat and back upholstery
• Back tube with lumbar curve
• Individual calf bands
• 20", 22", 24" PU tire (1 3/8") or Mag Wheels 20", 22", 24"
• 198 lbs. weight capacity
Material Number
Description
MSRP
480F53=60000_K
Start Junior - pediatric manual wheelchair
$1,872.00
Frame Colour (please select colour)
017
Yellow
N/C
018
Red
N/C
Seat Measurements (please select)
Seat width SW in inches
[ ] 11
[ ] 12
[ ] 13
[ ] 14
[ ] 15
Seat depth SD in inches
[ ] 12
[ ] 13
[ ] 15
Anterior seat height ASH in inches
[ ] 15
[ ] 16
[ ] 16.5
[ ] 17
[ ] 18
Posterior seat height PSH in inches
[ ] 14
[ ] 14.5
[ ] 15
[ ] 16
[ ] 16.5
Seat Height Measurements (please select)
[ ] 18.5
[ ] 17
[ ] 19
[ ] 20
[ ] [ ] 19
[ ] 19.5
Ottobock
P 800.665.3327 F 800.463.3659
www.ottobockmobility.ca [email protected]
6/19/2014
1
Prices are subject to change.
Seat Height Measurements - Please use appropriate matrix below to select the type of fork, a castor size and floor to seat height.
Start Junior Seat Height Matrix – Short Fork (Choose One)
Start Junior Seat Height Matrix – Short Fork w/ Spacer (Choose One)
Start Junior Seat Height Matrix – Long Fork (Choose One)
Ottobock
P 800.665.3327 F 800.463.3659
www.ottobockmobility.ca [email protected]
6/19/2014
2
Prices are subject to change.
Start Junior Seat Height Matrix – Long Fork w/ Spacer (Choose One)
Frame Accessories (Choose all that apply)
481A53=SK018
Crutch holder [ ] left
[ ] right
$48.88
481A53=SK200
Quantity [
]
Plug-on anti-tipper, short, each
$38.32
481A53=SK170
Quantity [
]
Plug-on anti-tipper, long, each
$38.32
481H53=SK012
Brake Extensions (each)
$24.44
481A53=SK013
Transport wheel, each
$81.69
446B1=2-7
Lap belt
$71.76
Adjustable Seat Upholstery (Please choose & Specify Dimensions)
SW: ________________
SD: _________________
SBK 13521.001
Seat Width: 14" - 15"
Seat Depth: 15"
N/C
SBK 24959.001
Seat Width: < 14"
Seat Depth: < 14"
N/C
Ottobock
P 800.665.3327 F 800.463.3659
www.ottobockmobility.ca [email protected]
6/19/2014
3
Prices are subject to change.
Back Upholstery (Please choose)
481D53=SK236
Back upholstery 11"
$153.92
481D53=SK237
Back upholstery 12"
$153.92
481D53=SK218
Back upholstery 13"
$153.92
481D53=SK219
Back upholstery 14"
$153.92
481D53=SK220
Back upholstery 15"
$153.92
481B53=PK130
Elevating Footrest (plastic footplate, black, angle adjustab
$414.96
481B53=LK128
Amputation Legrest, Left
$208.00
481B53=RK128
Amputation Legrest, Right
$208.00
481D53=SK065 (2)
Fold-down Backrest
$153.92
481D53=SK070 (3)
Back Angle Adjustment 30°
$398.32
Foot/Leg Rest Options
Back Options
(2) Only with lumbar curve and standard upholstery
(3) Only with back height 19" and standard upholstery
Arm Rests
481E53=PK010 (4)
481E53=PK001 (5)
Standard (Pair)
N/C
Height Adjustable With Side Panel
[ ] Desk Length [ ] Mid length [ ] Full Length
$222.56
(4) Standard equipment if height adjustable not checked
(5) Choose desired arm rest position
Rear Wheel Accessories (6)
481G00=SP830
20" Polished Stainless Steel Push Rim
$97.76
481G00=SP832
22" Polished Stainless Steel Push Rim
$97.76
481G00=SP834
24" Polished Stainless Steel Push Rim
$97.76
481G00=ST450
20" Silicone Push Rim Cover - sold individually
$88.40
481G00=ST452
22" Silicone Push Rim Cover - sold individually
$88.40
481G00=ST455
24" Silicone Push Rim Cover - sold individually
$88.40
481G00=SK722
20" Transparent Spoke Protector
$123.24
481G00=SK712
22" Transparent Spoke Protector
$123.24
481G00=SK702
24" Transparent Spoke Protector
$123.24
Ottobock
P 800.665.3327 F 800.463.3659
www.ottobockmobility.ca [email protected]
6/19/2014
4
Prices are subject to change.
Design Spoke Protectors
481G00=SK722
Spoke Protector Transparent 20˝ - Complete
$123.24
481G00=SK741
Spoke Protector Fire 22˝ - Complete
$193.44
481G00=SK743
Spoke Protector Fire 24˝ - Complete
$193.44
481G00=SK746
Spoke Protector Eye 22˝ - Complete
$193.44
481G00=SK747
Spoke Protector Eye 24˝ - Complete
$193.44
481G00=SK750
Spoke Protector Flower Power 22˝ - Complete
$193.44
481G00=SK749
Spoke Protector Flower Power 24˝ - Complete
$193.44
481G00=SK735
Spoke Protector Clown 22˝ - Complete
$193.44
481G00=SK736
Spoke Protector Clown 24˝ - Complete
$193.44
481G00=ST301
High Pressure Air Pump, 14 Bar
$191.36
481S53=ST001
Tool Set
481E53=ST046
Tray, Seat Width 11"
$321.36
481E53=ST047
Tray, Seat Width 12"
$321.36
481E53=ST048
Tray, Seat Width 13"
$321.36
481E53=ST049
Tray, Seat Width 14"
$321.36
481E53=ST050
Tray, Seat Width 15"
$321.36
481D53=SV016
Push Handles, Height Adjustable
$171.08
481E53=PK045
Side Panel, Clothing Protector
$210.08
481H53=PK026
Wheel Lock for User and Attendent
$414.96
481B53=SK010
Heel Band (each)
Accessories
$88.40
$51.53
Ottobock
P 800.665.3327 F 800.463.3659
www.ottobockmobility.ca [email protected]
6/19/2014
5
Prices are subject to change.

Download Report