j6 Ps Order Form Can

7/28/2019 j6 Ps Order Form Can

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J6 & J6 W/ PES

Order Form300 lbs. weight capacity

Revised: September 25, 2012 o

Client Height:

Client Weight:A. Seat Width:

B. Lateral Offset:

C. Hip/Thigh Lateral Offset:

D. Center of Gravity: Optimized based on seat dimension

E. Seat Depth:

F. Back Height from Pan:

G. Lateral Height from Pan:

H. Armrest Height from Pan:

I. Rigging Length (whole numbers only):

J. Seat to Floor Height: qLow qMiddle qTall

Clinician Notes:

SPECIFIED DIMENSIONS*

While every effort will be taken to ensure items will be preset to your

pecications prior to shipping, variations in options may effect nal settings.

Please supply patient information for optimal setup prior to shipping.

Pride Mobility Products Corporation380 Vansickle Rd. St. Catharines, ON L2R 6P7

Phone: (888) 570-1113 Fax: (866) 514-1303

Date:

PO#:

Account Number:

Bill To:

Address:

Phone Contact:

Ship To:

Address:

Marked For:

Discount:

Terms:

Freight:

LOWEST SEAT-TO-FLOOR HEIGHTS

Contoured Seating 20.5”Specialty Seat 16.75”Synergy Seat 16.625”*(PES option adds approximately 1.5” to the lowest STF height listed.

Seating Lowest Seat-To-Floor



J6 Order Fo


All prices are MSRP.

BASE MODELDescription Price

qJ6 $4295

qJ6 w/ Power Elevating Seat Option 1 $5095

COLORqJazzy RedqJazzy Blue

DRIVE WHEELS

q10” Solid (pair) Stdq10” Pneumatic (pair) NC

BATTERY CHARGER

q 5 Amp Offboard Std

ELECTRONICS for non power elevating seat

q 75 Amp NE (not available w/ PES) Std

Description Price

JOYSTICK MOUNTING BRACKETS

FOOTNOTES. Only Available with VSI 6-Key Joystick. Includes 1/4 Speed Inhibit. Raises Seat-To-

Floor Height. NA with Synergy Manual Tilt or Recline.

. Includes black vinyl seatpan. Back available in listed colors.

. Call for conguration options with Shape Back

. Flip-up arms may interfere with swing-away laterals

5. Adjustable from 11" to 17" in .5" increments

. Not available with Waterfall Armpads

ELECTRONICS 1 for power elevating seat

q VSI 6-Key1 (required for PES) Std with PES

qBase Mounted Foot Platform StdqNo Base Mounted Front Platform NC

BASE MOUNTED FOOT PLATFORM

qFixed Inline StdqLeft qRight

qSwing-away $250qLeft qRightqInline qOffsetq4” Ext. q7” Ext.

qMulti-axis Fixed $200qLeft qRight(Fixed conguration. Does not swing away)

CONTOURED SEATING

MANUAL RECLINER

Armrests:qManual Recliner High Back with Headrest $6

qManual Recliner High Back with Headrest and Solid Seat Pan2 $6

Upholstery:

qBeige Vinyl qGray VinylSeat Width:

q16” $95 q18”Seat Depth:

q16” $95 q18”

SPECIALTY SEAT

Medium Back:qMed-Back Std

qMed-Back with Solid Seat Pan2 NC

High Back:qLimited Recline High-Back with Headrest $70

qLimited Recline High-Back with Headrest & Solid Seat Pan2 $70

Upholstery:

qBrown Vinyl qBeige Vinyl qGray Vinyl

qBlack Vinyl qGray Fabric qBrown Fabric

Seat Width:

q16” $95 q18” Std q20” $95

Seat Depth:

q16” $95 q18” $95 q20” Std

Seat Width:

q16” q18”

Seat Depth:

q16” q18”Upholstery:

qBrown Vinyl qBeige Vinyl qGray Vinyl

qBlack Vinyl qGray Fabric qBrown Fabric

Armrests:qFlip-Up, Removable Std

qFlip-Up, Height-Adjustable, Removable NC

Armpads:Left: qFull Length qDesk Length

Right: qFull Length qDesk Length

Depth Adjustable High Back:qLimited Recline Gray Vinyl Depth Adjustable $1

High Back w/ Headrest

q18”W x 18-20”D q20”W x 18-20”D

qSpecialty Seat Kit $3

Seat Width:

q16” q18” q20”Seat Depth:

q16” q17” q18” q19”

q20”Back Cane Height:

q18” q20” q22”

Armrests for Specialty Seating:q2-Post, Fixed Height, Flip Back3,4 NC

qFlip-Back, Cane Mounted3,4 $1

qRemovable, Quick Height Adjustable5 $1

qRemovable, Heavy Duty, Height Adjustable $1

q8-12” Adjustment range q10-14” Adjustment range

Armpads:Left: qFull Length qDesk LengthRight: qFull Length qDesk Length

Sling Back: $13

q16” W q18” W q20” W



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SYNERGY ® SEATING SYSTEMSDescription Price

eat Width:

q10” q11” q12” q13”

q14” q15” q16” q17”

q18” q19” q20”

eat Width Package:

q10”W-14”W q14”W-18”W q16”W-20”W

eat Depth:

q10” q11” q12” q13”

q14” q15” q16” q17”

q18” q19” q20”

eat Depth Package:

q10”D-14”D q14”D-18”D q16”D-20”D

Back Cane Height:

q14" q15" q16" q17"

q18” q19” q20” q21"

q22” q23” q24” q25”

BACK CANE OPTIONS

BACK OPTIONS

FOOTNOTES

1. N/A with Power Elevating Seat Option

2. Requires Solid Curved Back not included

3. Not available with Synergy Manual Recline, Synergy Manual Tilt, vent tray, baria

armpads, Tru-Comfort or sling back. May interfere with with lateral supports and

Waterfall Armpads.

4. Available with Tru Comfort seating only through SOF. Not available with SynergyManual Recline. Flip Back armrests may interfere with offset canes.

5. Interferes with swing-away laterals.

6. Adjustable from 11"-17" in 1/2" increments

7. Desk Length armrests with an accessory may interfere with access to headjustment lever. Adjustable Height from 7.75" to 9.75".

8. Height adjustment from 11-17" depends on cane height. Not available wManual Recline, Flip Forward back canes, Cane Clamp Pushbar, & ShapBack. Call for details when selecting aftermarket arm troughs or UniversSwivel.

9. TRU-ComfortTM Headrests are measured at the front of the headrest

qSynergy Seating Frame $995

qSynergy Manual Recline Package1,2 $625

qSynergy Manual Tilt Package1 $925Max. Seat Size 14”W x 14”D, 75 lbs Weight Capacity

qStandard Back Canes With Push Handles Std

qStandard Back Canes, No Push Handles $85

qFlip Forward Canes3 $150qOffset (Meso)4 $195

q2” (1” Per Side) q4” (2” Per Side)

qInset (Endo)4 $195

q2” (1” Per Side) q4” (2” Per Side)

qSynergy Back with 1.5” Thick Back Cushion $450

Back Height:

q18” q19”q20” q21”

q22” q23” q24” q25”

Lateral mounting rails:

q6” extension/height (For back heights 13”-16”H) $25

q10” extension/height (For back heights 17”-18”H) $25

q12” extension/height (For back heights of 19”H-22”H) $25

q16” extension/height (For back heights of 23”H-25”H) $25

qSynergy Shape Backs VariousSee Synergy Shape Back Order Forms For Detailed Pricing and Sizes

qSling Back $135

qOmit Backq TRU-Comfort™ Back 4-way Stretch Material Cover

A with Specialty Seat.

verall back height measured from top of seat pan to top of back +- 1/2”

Width: q 16”W q 18” W q 20”W $695Height: q 20” H q 21” H q 22”H q 23”H

q 24”H q 25”H q 27”H q 28”H

Width: q 17”W q 19”W $695Height: q 22”H q 23”H q 24”H q 25”H

q 27”H q 28”H

ru Comfort Colour Shroud Option:

q Black (Standard color option) NCq Colour Match Base $150

Description Price

ARMRESTS for Synergy seat only

qStraight, Full Length (2”x14”) StdqLeft qRightqStraight, Desk Length (2”x10”) NCqLeft qRightqWaterfall, Full Length (2”x14”) NC qLeft qRightqWaterfall, Desk Length (2”x14”) NC qLeft qRight

ARMPADS

qFlip-back, Cane Mounted5 Stdq2-post, Flip-back, Height-adjustable, Removable5 $138

(9”-13” of height adjustment in 1” increments)

qSingle-post, Height-adjustable, Removable6 $123qQuad Release Lever qRemovable, Single-post, Height Adjustable, Heavy Duty $123 q8”H - 12”H q10”H-14”HqPediatric, Removable7 $123ea Color: qMatch Shroud qBlack qQuad Release Lever

(7 3/4” - 9 3/4” height adjustment in 1/2” increments from seat pan to top of arm

qHeight-adjustable Cantilever Armrests (SOF) 8 $138 Angle-Adjustable: - 30 o through + 30 o

HEADRESTS

qNo Headrest Required

TRU-Comfort™ 9

q8”W TRU-Comfort Plus $325

q10”W TRU-Comfort Plus $325

qRemovable Headrest Bracket $180

Headrest measurement is taken from the inside of the headrest

POSITIONING COMPONENTS

q Stealth Thoracic Laterals (pair)Bracket:

q Swing-Away Rail Mount Bracket $50(For Use With Synergy Back and Tru Comfort Back)

Choose Pad:

q Flat Pad, 3” x 5” Leather-Like Cover $22 q Flat Pad, 4” x 6” Leather-Like Cover $22 q Curved Pad, 2” x 3” 4-Way Stretch Cover $22 q Curved Pad, 3” x 5” 4-Way Stretch Cover $22 q Curved Pad, 4” x 6” 4-Way Stretch Cover $22



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STANDARD LEGRESTS

FOOTNOTES

. Extensions are measured from top of seat pan to footplate

2. Standard with angle adjustable footplates with heel loops.

3. Available only with ELR's

4. Available only on seats 18"W or greater

5. Available only on seats 20"W

6. Available only on swing-away legrests.

7. Swing-away laterals interfere with ip back armrests.

8. Includes mounting hardware. Not available with Tru Balance Manual Recline or

Manual Recliner.

9. Not available with manual recline, includes mounting hardware. Tru Comfort Back

requires custom O2 holder, call for details.

0. Available with Synergy armrests only

q70o Swing-away Legrests1 $270

qStraight qTapered

q Standard Extruded Footplates StdExtensions Length:

q11”-13” q13”-16.5” q15.5”-19.5”Footplates Size:

q7.25” x 6” q8.5” x 6”

q Angle-Adjustable Footplates $165Extensions Length:

q11”-13”

q13”-16.5”

q15.5”-19.5”Footplates Size:

q4” x 6” q5” x 6” q5” x 8”

q6” x 8”4 q6” x 11”4 q8” x 11”5

q Multi-Axis Footplates $495Extensions Length:

q11”-16.5” q15.5”-19.5”Footplates Size:

q4” x 6” q5” x 6” q5” x 8”

q6” x 8”4 q6” x 11”4 q8” x 11”5

qHigh Mount, Clamp-On Footrestq Angle Adjustable $450

qSmall, 4” x 7.75” qLarge, 4.25” x 9.25”qMulti-Axis $465

qSmall, 4” x 7.75” qLarge, 4.25” x 9.25”

qHeavy Duty Drop-In Legrests

1,2

$420q Angle Adjustable Footplates Std

Extension Length:

q12”-14.5” q14.5” -18”Footplate Size:

q4” x 6” q5” x 6” q5” x 8”

q6” x 8”4 q6” x 11”4 q8” x 11”5

qElevating Legrests1 $520

q Standard FootplatesExtension Length:

q11”-14” q14”-17”Footplate Size:

q7.25” x 6” q8.5” x 6”

q Angle Adjustable Footplates $165

Extension Length:

q12”-14.5” q14.5” -18”

Footplate Size:

q4” x 6” q5” x 6” q5” x 8”

q6” x 8”4 q6” x 11”4 q8” x 11”5

q Calf Pad Adjustment3

q1 Hole q3 Hole q6 Hole

qPediatric Swing-Away Legrests1 $270

q Angle Adjustable Footplates $165Extension Length:

q7”-10”Footplate Size:

q4” x 6” q5” x 6”

Description Price

FRONT RIGGING ACCESSORIES

Description Price

HIGH MOUNT FOOT PLATFORM

qHigh Mount Foot Platform $45

q10”-14” Ext.1 q14”-17” Ext.1

qWheel Bumpers $2qHeel Loops (pair)2 $3qGel Neoprene Footrest Sleeve (pair)6 $1qELR/ALR Adductor Buttons (pair) $1qResidual Limb Support $2

qLeft qRight

(See Quantum accessories order form for additional options)

SYNERGY ® CUSHIONS

qNo Cushion RequiredPlease refer to Synergy order forms for detailed pricing and sizes.

Simplicity Cushion General Use

q16” x 16” - 20” x 20” $1Solution® 1 Cushion Skin Protection

q14” x 14” - 20” x 18” $2q20” x 20” $3Solution® Cushion Skin Protection & Positioning

q10” x 10” - 18” x 22” $3

q19” x 17” - 20” x 20” $4Solution® 1 LTC Cushion Skin Protection & Positioning

q14 x 16 - 20 x 20 $5Spectrum® Gel Cushion Positioning

q12” x 10” - 19” x 19” $5q20” x 16” - 20” x 20” $5Spectrum® Visco Cushion Skin Protection & Positioning

q10” x 10” - 19” x 19” $5q20” x 16” - 20” x 20” $5Spectrum Air Skin Protection q14” x 12” - 20” x 20” $5Spectrum Air Contour Skin Protection & Positioning q14” x 12” - 20” x 20” $6TRU-Comfort™ Seat Cushion General Use

q16” x 16” - 20” x 20” $3qPlus 4-way stretch material cover

ACCESSORIES

LAP BELTS

BATTERIES

qU-1, 32 Amp, Gel $180ea

qRear Basket8 $120

qCane/Crutch Holder 8 $120

qOxygen Holder Contoured Seating 8 $85

qOxygen Holder Synergy Seat 9 $85

qWalker Holder 8 $120

qFlag Holder $32

qStroller Handle Manual Tilt Only $85

qWeather Cover, Medium, Black $225

qCup Holder $32

qLeft qRight

qSaddle Bag $28q Tablet Holder 10 $395q Cell Phone/Media Holder 10 NC

q Deluxe Cell Phone/Media Holder 10 $175

q38” Lap Belt $24

q50” Lap Belt $24

q60” Lap Belt $24

q70” Lap Belt $24

q80” Lap Belt $24

q90” Lap Belt $24

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