Page 1 of 2INFINFB3885/RevB/13NOV2017

Grandeur Collection, LC-515iL, Quick Ship, Order Form

Pride Mobility Products Corp.182 Susquehanna Ave., Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: prideorders@pridemobility.com

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power lift recliner. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.

Thank you for choosing Pride® Mobility Products!

Introduction

LC-515iL .............................................................................................................................................................................................$1,699Part: L515ILMODELHCPCS: E0627, seat lift mechanism, electric, any type.

See Multiple Unit Order on page 2.

Grandeur Collection single chair order5'4" to 6' height range, 21" seat width, and 375 lbs weight capacity.

Select a fabric and color for a single chair orderSelect a Color

Cloud 9 Fabrics

Black Cherry ........................................ StandardPart: FABXESP

Pacific ................................................... StandardPart: FABCCG

Stone ..................................................... StandardPart: FABXPRD

Walnut ................................................... StandardPart: FABXPLU

Espresso ...................................................... $250Part: FABXESP

Cool Grey ..................................................... $250Part: FABCCG

Plush Red ..................................................... $250Part: FABXPRD

Plush Lazuli ................................................. $250Part: FABXPLU

Sand .............................................................. $250Part: FABXSAN

Crypton® Aria FabricsNot a Quick Ship fabric. May increase lead time.

https://get.adobe.com/reader/http://cross-reference spreadsheet

Page 2 of 2INFINFB3885/RevB/13NOV2017

© 2017 Pride Mobility Products Corp. All rights reserved.

youtube.com/pridemobility

facebook.com/PrideMobilityProductsCorp

twitter.com/pridemobility

instagram.com/PrideMobilityProducts

LIFT

Pride Mobility Products Corp.182 Susquehanna Ave., Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: prideorders@pridemobility.com

Account Number: ___________ Date: ________________ Marked for: _____________________________________

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

Head Pillow .....................................$50Part: See XRef

Bolster Pillow .................................$50Part: See XRef

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

Deluxe Heat and Massage ..........$300Part: ELE160765

Select upgrades and accessories for a single chair order

Select a fabric and color for a single chair order, continued

Resi

dent

ial

Clea

ning

Kit

Prot

ecti

ve P

ad

Head

Pil

low

Bols

ter

Pill

ow

Delu

xe H

eat

and

Mas

sage

LC51

5iL

$1,

699

Blac

k Ch

erry

Paci

fic

Ston

ewa

lnut

Espr

esso

Cool

Gre

yRe

dLa

zuli

Sand

Buff

Fudg

eGa

rnet

Char

coal

Peca

nMultiple Chair OrderPlease see page 1 for pricing, details, and limitations. Enter a quantity below and then place check marks in the field with the desired option.

3-Position (Full Recline)Full recline can be achieved on 3-position Pride Power Lift Recliners after fully elevating the legrest. Infinite Position chairs can operate legrest and backrest independently.

Zero Gravity PositionThe zero gravity position can be reached with Infinite-Position Pride Power Lift Recliners. This positions one’s thighs and lower legs higher than their torso.

2-Position (TV Recline)TV recline can be achieved on all Pride Power Lift Recliners. This features elevat-ed footrest and sightly reclined backrest.

Trendelenburg PositionThe Trendelenburg position, elevates one’s feet higher than his or her head for increased comfort and relaxation.

Power Lift Recliner Position ReferenceThe Grandeur Collection is an Infinite position power lift recliner. The infinite position allows the backrest and footrest to move independently from one another so that a variety of positions can be reached; including TV recline, full recline, zero gravity and trendelendurg positions.

True Infinite PositionInfinite-position Pride Power Lift Recliners enable the backrest and footrest to move independently from one another so that a variety of positions can be reached. The Infinite position can achieve two, three, infinite, zero gravity and Trendelenburg positions.

Buff ................................................................$630Part: FABUBUF

Fudge ............................................................$630Part: FABUFUD

Garnet ...........................................................$630Part: FABUGAR

Charcoal .......................................................$630Part: FABUCL

Pecan ............................................................$630Part: FABUPEC

Ultraleather™ FabricsNot a Quick Ship fabric. May increase lead time.

UpgradesQTY Model Cloud 9 Aria CryptonUltraleather

https://www.youtube.com/user/PrideMobilityhttps://www.facebook.com/PrideMobilityProductsCorphttps://www.twitter.com/PrideMobilityhttps://www.instagram.com/pridemobilityproducts/

Option Name On-chair Price Part Number Manufacturer Extended DescriptionLumbar Pillow $50 UPSHDPL8110001 PILLOW,HEAD,BLACK CHERRY

$50 UPSHDPL8110002 PILLOW,HEAD,PACIFIC$50 UPSHDPL8110004 PILLOW,HEAD,STONE$50 UPSHDPL8110005 PILLOW,HEAD,WALNUT$50 UPSHDPL1445 PILLOW,HEAD,ESPRESSO(ARIA)$50 UPSHDPL1450 PILLOW,HEAD,COOL GREY(ARIA)$50 UPSHDPL1448 PILLOW,HEAD,PLUSH RED(ARIA)$50 UPSHDPL1446 PILLOW,HEAD,PLUSH LAZULI(ARIA)$50 UPSHDPL1449 PILLOW,HEAD,SAND(ARIA)$50 UPSHDPL1215 PILLOW,HEAD,ULTRALEATHER BUFF$50 UPSHDPL1214 PILLOW,HEAD,ULTRALEATHER FUDGE$50 UPSHDPL1216 PILLOW,HEAD,ULTRALEATHER GARNET$50 UPSHDPL1455 PILLOW,HEAD,ULTRALEATHER CHARCOAL$50 UPSHDPL1220 PILLOW,HEAD,ULTRALEATHER PECAN

Bolster Pillow $50 UPSBOLT8110001 PILLOW,BOLSTER,BLACK CHERRY$50 UPSBOLT8110002 PILLOW,BOLSTER,PACIFIC$50 UPSBOLT8110004 PILLOW,BOLSTER,STONE$50 UPSBOLT8110005 PILLOW,BOLSTER,WALNUT$50 UPSBOLT1576 PILLOW,BOLSTER,ESPRESSO(ARIA)$50 UPSBOLT1581 PILLOW,BOLSTER,COOL GREY(ARIA)$50 UPSBOLT1579 PILLOW,BOLSTER,PLUSH RED(ARIA)$50 UPSBOLT1577 PILLOW,BOLSTER,PLUSH LAZULI(ARIA)$50 UPSBOLT1580 PILLOW,BOLSTER,SAND(ARIA)$50 UPSBOLT1198 PILLOW,BOLSTER,ULTRALEATHER BUFF$50 UPSBOLT1197 PILLOW,BOLSTER,ULTRALEATHER FUDGE$50 UPSBOLT1199 PILLOW,BOLSTER,ULTRALEATHER GARNET$50 UPSBOLT1586 PILLOW,BOLSTER,ULTRALEATHER CHARCOAL$50 UPSBOLT1206 PILLOW,BOLSTER,ULTRALEATHER PECAN

Grandeur Collection Power Lift Recliners Cross Reference SpreadsheetUpgrades and accessories

Sheet2

Button 55: Page 1: Page 21:

aButton 45: Page 1: Page 21:

Print Form 2: Page 1: Page 21:

SubmitViaEmail 2: Page 1: Page 21:

Provider Name: Contact: PO Number 3: Ship to address: Email 3: City: State: Zip 3: Phone 3: Fax 3: model: Offsinglecolor: OffText Field 246: Account Number: Date: Marked for: accessories6: Offaccessories7: Offaccessories8: Offaccessories8z: OffText Field 239: accessories10: OffText Field 252: Text Field 253: Text Field 254: Text Field 255: Text Field 256: Text Field 207: upgrades2: Offupgrades3: Offupgrades4: Offupgrades5: Offmulti model: Offcolor: Offcolor : Offupgrades1: Offupgrades 2b: Offupgrades 2ad: Offupgrades 2: Offmulti model2: Offcolor 2: Offupgrades2c: Offupgrades 3b: Offupgrades 3c: Offupgrades 3d: Offupgrades 3w: Offmulti model 3: Offcolor 3: Offupgrades 3a: Offupgrades 4b: Offupgrades 4c: Offupgrades 4d: Offupgrades 4w: Offmulti model 4: Offcolor 4: Offupgrades 4a: Offupgrades 5b: Offupgrades 5c: Offupgrades 5d: Offupgrades 5w: Offmulti model 5: Offcolor 5: Offupgrades 5a: Offupgrades 6b: Offupgrades 6c: Offupgrades 6d: Offupgrades 6w: Offmulti model 6: Offcolor 6: Offupgrades 6a: Off