160 Armand-Majeau Sud

Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0

T.+1-866-650-6555 F. +1-888-966-6555

orders@motioncomposites.comwww.motioncomposites.com

MOVEORDER FORM - CANADA

P.O. number:* Date: Ship to:*

Company Name:* Phone:* Name:

Ordered by:* Address:

Clinician/ATP/RTS: City: Prov:

Email: Postal Code:

Marked for: Phone:

* Required

MODEL

1 WC01 Ultralight MOVE wheelchair aluminum. (265 lb weight capacity) $1 395 □

2 WC09 Heavy duty kit (350 lb weight capacity) $775 □

SEAT WIDTH 3

3 SW Seat width: 14" □ 16" □ 18" 1 □ NC □

4 SW Seat width: 20" 1 □ 22" 2 □ $295 □

SEAT DEPTH

5 SD Seat depth: 16" □ 18" □ NC □

6 SD Seat depth: 20" □ $225 □1 - Available with HD option 2 - Only available with HD option 3. Width calculator

STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2"

P1 12 1/2 13 1/2 14 1/2

P2 13 14 15 13 1/2 14 1/2 15 1/2

P1

P2 13 14 15 13 1/2 14 1/2 15 1/2

P3 13 1/2 14 1/2 15 1/2 14 15 16 14 1/2 15 1/2 16 1/2

P4 14 15 16 14 1/2 15 1/2 16 1/2 15 16 17 15 1/2 16 1/2 17 1/2

P1 15 1/2 16 1/2 17 1/2 16 17 18

P2 15 1/2 16 1/2 17 1/2 16 17 18 16 1/2 17 1/2 18 1/2

P3 16 17 18 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2

P4 16 17 18 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2 18 19 20

P5 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2 18 19 20 18 1/2 19 1/2 20 1/2

Height available +- 1/4" (see stem bolt and fork combination at the end of the order form)

WAMB

WAMA

MA080

English Manual (STD)

MA081

Manuel FrançaisTaxes not included

WM0001196

WAMF

5.1

Fork/Position

4"

5"

7"

Move FRONT Seat-to-floor Height - Please select your choice4" caster 5" caster 6" caster 7" caster 8" caster

Stem bolt length Stem bolt length Stem bolt length Stem bolt length Stem bolt length

Motion CompositesT.450 588-6555 1 866 650-6555 F.1 888 966-6555 MOVE Orderform CAN 5.1.xlsx March 23rd, 2020 1 of 5

CASTERS

7 CA01 Composite wheel w/ PU tire (1" width) 4" □ 5" □ 6" □ 7" □ 8" □ NC □

8 CA10 Pneumatic 6" x 1 ¼" $160 □

9 CA11 Pneumatic 8" x 1 ¼" $160 □

10 CA14 4" x 1 ½ " $98 □

11 CA15 5" x 1 ½ " $98 □

12 CA16 6" x 1 ½ " $98 □

13 CA17 4" x 1 ½" $175 □

14 CA18 5" x 1 ½" $185 □

15 CA19 6" x 1 ½" $195 □

Note: Tire size, center of gravity setting and seat slope may result in a variation of +/- ½” of selected seat to floor height"

SWING-AWAY FOOTREST

16 FR01 60° swing away footrest 13.5 - 17.5" □ 15.5 - 19.5" □ 17 - 21" □ $250 □

17 FR02 70° swing away footrest 13.5 - 17.5" □ 15.5 - 19.5" □ 17 - 21" □ $250 □

FOOTREST OPTIONS

18 FR09 High mount (footplate attached to the hanger with clamps) 5 - 13.5" □ $90 □

* +/- 1/2"

ELEVATING LEGREST (unit) The elevating legrest replace the footrest side selected

19 FR10 Elevating legrest with calf pad, 14” - 22” Length adjustable Left □ Right □ $390 □

FOOTPLATES

20 FP01 STD □

21 FP02 Newton adjustable angle - Composite $145 □

22 FP03 $165 □

23 FP08 Length adjustable heel loop $25 □

24 FP09 Calf strap $52 □

25 FP30 Bodypoint Aeromesh Padded calf strap $129 □

26 FR27 Residual limb support swing away - flat 6"x8" Left □ Right □ $475 □

27 FR28 Residual limb support swing away - flat 8"x10" Left □ Right □ $475 □

28 FR29 Residual limb support swing away - flat 10"x10" Left □ Right □ $475 □

29 FR30 Residual limb support swing away - flat 10"x14" Left □ Right □ $475 □

30 FR32 Residual limb support swing away - contour 6"x8" Left □ Right □ $475 □

31 FR33 Residual limb support swing away - contour 8"x10" Left □ Right □ $475 □

32 BC01 8° bend aluminum back cane 16" □ 18" □ 20" STD □ NC □

ADJUSTABLE ANGLE BACK

33 BC02 8° bend aluminum back cane 16" □ 20" STD □ $309 □

34 90° □ 95° STD □ 100° □ 105° □ 110° □

New

19 1/4" 20"

Select back cane angle:

Standard - Composite

18"

Set at:*

Back canes with integrated fixed height push handle FIXED ANGLE BACK

16 1/4"

WAMK

18 1/4"

Set at:*

17 1/4" 18"

Set at:

19"

SEFND0010

FOOTPLATE ACCESSORIES

Footrest

13"

15"

15 1/4"

14 1/4"

16"

18"

17 1/4"

16"

SEFND0010

19"

17"

Move REAR Seat-to-floor Height - Please circle your choice

14 1/4"

15 1/4"

17"

14"

14"

20" 22" 24"

12 1/4"

16"

17"

Set at:*

Newton adjustable angle - Aluminum

Newton UltraCaster Soft-Roll Aluminum

15"

16 1/4"

25"

15"

WAMJ

WAMJ

26"

13 1/4"

Newton UltraCaster Soft-Roll Composite

SEFND0005

SEFND0005

RESIDUAL LIMB SUPPORT CONTOUR CUSHION (Swing away, depth, width, height and angle ajustable) - (unit)

SEFND0005

RESIDUAL LIMB SUPPORT FLAT CUSHION (Swing away, depth, width, height and angle ajustable) - (unit)

New SEFND0005

SEFND0005New

New

New

New

SEFND0005

Motion CompositesT.450 588-6555 1 866 650-6555 F.1 888 966-6555 MOVE Orderform CAN 5.1.xlsx March 23rd, 2020 2 of 5

35 PH04 Stroller handle (not available with the HD option) $210 □

36 PH03 Folding stabilizer bar $258 □ 1 - Stroller handle and stabilizer bar can't be combined

BACK UPHOLSTERY

37 BH05 Slip-on Nylon back upholstery NC □

38 BH06 Adjustable tension Nylon back upholstery $245 □

39 BH99 Omit back upholstery STD □

RIGID BACK

40 NXT back series □

SEAT CUSHIONS

41 SC01 2" Cushion $175 □

42 SC02 3" Cushion $195 □

43 SC99 NC □

44 NXT FIT cushion series □

ONE ARM DRIVE 1 Only available with Newton One rear wheels with Aluminum, Plastic coated Handrims

45 HR22 One arm drive 2, 3 24" left □ right □ $1 395 □

46 HR98 Omit handrim on opposite side of the One Arm Drive (OAD) NC □

REAR WHEELS

47 RW01 Mag 4 20" □ 22" □ 24" □ NC □

48 RW02 Newton One - spoke wheel 5 20" □ 22" □ 24" □ NC □

49 RW03 Newton Gravity - ultralight wheel 20" □ 22" □ 24" □ 25" □ 26" □ $360 □

TIRES

50 TI01 Soft Urethane 1 1/4 " STD □

51 TI02 Soft Urethane knobby 1 3/8 " $130 □

52 TI04 Soft Urethane - Shox 1" $155 □

53 TI05 Pneumatic 1 3/8 " $130 □

54 TI08 Pneumatic with Airless insert 1 3/8" $215 □

55 TI06 Pneumatic HP - 1" $150 □

56 TI07 Pneumatic HP - Schwalbe Marathon Plus 1'' $230 □ 1- Offered with handrims on each side of the wheelchair 2- Only standard handrim position available 3- Not available with HD option

4 - Not compatible with HP tires ; Only available with aluminum or plastic coated handrim in standard position 5- Not compatible with Shox tires

HANDRIM

57 HR01 STD □

58 HR02 $160 □

59 HR03 $430 □

60 HR07 Newton Air Grip 1 Noir □ $150 □

Newton Air Grip 1 (08) Sunkissed Orange □ (09) Burgundy □ (10) Sapphire Blue □

(11) Monster Green □ (12) Charcoal □ (13) Fuchsia □ (14) Steel Blue □

(15) Ferrari Red □ (16) Acid Green □ (17) White □ (18) Sky Blue □

62 HR28 Surge 1, 2, 3 (1-1/2" Oval handrim w/ Gripton high friction strip) $470 □

63 HR05 Surge LT 1, 2, 3 (1-1/8" Oval handrim w/ Gripton high friction strip) $500 □

64 HR04 Natural Fit 1, 2, 3 $500 □

65 HR99 NC □ 1 - Not available with Mag wheels or OAD 2 - Not available in 20" 3- Only standard handrim position available

Assembly position for aluminum and Newton AirGrip handrims

66 HR29 Standard Handrim position Full tab STD □

67 HR30 Narrow Handrim position Short tab 2 positions $25 □

68 HR31 Super Narrow Handrim Short tab 2 positions STD □ Short tab 1 position □ $25 □

Thumb piece4 selection Natural Fit handrims

69 HR23 Standard grip $190 □

70 HR27 Super grip $220 □

71 HR099 Omit thumb piece NC □ 4- Compatible with Surge, Surge LT handrims

See pricelist p.6

WAMO

WAMO

Rear wheels

Handrims

Handrims option

WAMO $330

WAMW

WAMO

STROLLER HANDLE AND STABILIZER BAR 1

See pricelist p.6

□

WAMD/WAME

24", 25", 26"

Plastic coated 3

Aluminum anodized

Q-Grip High friction Neoprene coated 1, 2, 3

Available

20", 22" 24"

22", 24", 25", 26"

22", 24", 25", 26"

20", 22", 24", 25", 26"

22", 24"

20", 22", 24", 25", 26"

61

Omit seat cushion

HR08

Omit handrim

Motion CompositesT.450 588-6555 1 866 650-6555 F.1 888 966-6555 MOVE Orderform CAN 5.1.xlsx March 23rd, 2020 3 of 5

AXLES (0° camber)

72 AX01 Quick release axle STD □

73 AX02 Permanent axle NC □

74 AX03 Quad release axle $170 □

AXLE PLATE

75 AX04 Amputee adjustable axle plate 1 $250 □1 - May limit seat to floor height available

Choose position of rear wheel axle plate:

Measure distance from front of back post to center of axle receiver.

Default setting is at 3/4"

Most stable Most responsive

AMPUTEE 3/4" 2"

□ □ □

WHEEL LOCKS

76 WL08 Newton Wheel lock - push to lock STD □

77 WL02 Pull to lock NC □

78 WL04 Newton grade aid push to lock (suggested with pneumatic or high pressure tire) $175 □

79WL13

WL14 6" removable extension handle $67 □

80 WL06 $230 □

81 WL99 NC □

FLIP BACK ARMREST (Convertible to "T" armrest) 1, 2 Height Adjustment

82 AR01 10" Desk length arm pad 8 - 12" STD □ 10 - 14" □ $380 □

83 AR02 14" Full length arm pad 8 - 12" STD □ 10 - 14" □ $380 □

"T" ARMREST 1 Height Adjustment

84 AR03 8 - 12" STD □ 10 - 14" □ $360 □

85 AR04 8 - 12" STD □ 10 - 14" □ $360 □

GEL ARM PAD

86 AR12 14'' Full Length Arm Pad - Gel Ovation $150 □

87 AR99 NC □ 1 - May have a 1/2 " adjustment restriction on both limits of the range 2- Not available with attendant lock

POSITIONING BELTS

88 SB01 Velcro adjustable Standard 35" □ Long 60" □ $45 □

89 SB02 Auto buckle Standard 35" □ Long 60" □ $55 □

90 SB07 Hardware attachment for 2 point seatbelt (1 pair) NC □

91 SB03 $13 □

92 SB04 BodyPoint Hip Belt - 2 point not padded Medium 56" □ Long 61" □ $82 □

93 SB05 BodyPoint Hip Belt - 2 point padded Small 51" □ Medium 56" □ Long 61" □ $170 □

94 SB06 BodyPoint Hip Belt - 4 point padded Small 51" □ Medium 56" □ Long 61" □ $195 □

95 SB08 BodyPoint EVOFLEX® Positioning Belt Rehab latch and Band Clamps Medium 18"□ Long 24" □ $324 □

96 SB99 Omit positioning belt NC □

97 AC01 Profiled Headrest Small (3.5"X6") □ Medium (4.5"X7") □ Large (5.5"X8") □ $205 □

98 AC28 Headrest mounting hardware with stabiliser bar $338 □1 - Not available with a stroller handle or a folding stabiliser bar

SERND0030

SERND0020

Omit armrest

Locked □ Unlocked □ STD

Locked □ Unlocked □ STD

WAMU

14" Full length arm pad

Additional hardware for 2 extra attachment points (needed for the 4 point seat belt) (1 pair)

HEADREST 1

SEAND0030

Attendant Lock (additional set of wheel lock mounted to the back)

10" Desk length arm pad

Removable function

Omit wheel locks

WAMR

WAMT

CENTER OF GRAVITY

Armrests

WAMU

Motion CompositesT.450 588-6555 1 866 650-6555 F.1 888 966-6555 MOVE Orderform CAN 5.1.xlsx March 23rd, 2020 4 of 5

ACCESSORIES

99 AC03 Anti tippers $115 □

100 AC27 Tip assist 1 $60 □

101 AC04 Transit Tie Down (Unoccupied) NC □

102 AC05 WC-19 Transit Tie Down w/Q'straint belt 2 Short belt 20-41" □ Long belt 20-46" □ $345 □

103 AC06 Cane carrier Left □ Right □ $105 □

104 AC07 Left $375 □

105 AC08 Spoke guards 3 Available: 20", 22", 24", 26" $145 □

106 AC09 Footrest neoprene impact guard (pair) - Black $80 □

107 AC10 Seat pouch $95 □

108 AC26 BodyPoint Mobility Bag $135 □

109 AC23 Newton Backpack $120 □

110 AC12 Velcro Closing Strap $50 □

111 AC13 Tool kit $50 □

W/S □ W/M □ W/L □

M/S □ M/M □ M/L □ M/XL □ M/XXL □ M/XXXL □ M/XXXXL □

1 - Cannot be combined with Anti Tippers 2 - Not available with HD option

3 - Not available with Mag wheels

113 FC01 Black □ NC □

Sunkissed Orange □ Burgundy □ Sapphire Blue □ Monster Green □

Charcoal □ Fuchsia □ Steel Blue □ Ferrari Red □ Acid Green □

115 FC99 Custom Color Specify PPG Paintit color: $410 □

Notes :

WAMX

Fork and Stem bolt combinations

FRAME COLOR (with black aluminum crossbrace)

114 $270 □FC03

TOTAL

SEFND0035

Oxygen tank holder - E Type Not compatible with swing away armrest or amputee axle plate

WAMP

112 AC16 □$32 Motion Composites Polo shirt

Additional 10 days

lead-time

Motion CompositesT.450 588-6555 1 866 650-6555 F.1 888 966-6555 MOVE Orderform CAN 5.1.xlsx March 23rd, 2020 5 of 5

SEATING SERIES – FOLDING ON CHAIR – CANADIAN ORDER FORM Effective: March 2020

BioFit™ Fits Width Depth $ 3

NXCABF1616 15”-16” 16” 595

NXCABF1618 15”-16” 18” 595

NXCABF1620 15”-16” 20” 595

NXCABF1816 17”-18” 16” 595

NXCABF1818 17”-18” 18” 595

NXCABF1820 17”-18” 20” 595

BioFit™

BioFit™ CUSHION

Optima™ THORACIC BACK SUPPORT

Optima™ Fits Width Height $ 3

NOACB1613 16”-18” 13” 690

NOACB1616 16”-18” 16” 690

NOACB1619 16”-18” 19” 690

NOACB1813 18”-20” 13” 690

NOACB1816 18”-20” 16” 690

NOACB1819 18”-20” 19” 690

NOACB2016 20”-22” 16” 690

NOACB2019 20”-22” 19” 690

NOACB2213 22”-24” 13” 720

NOACB2216 22”--24” 16” 720

NOACB2219 22”-24” 19” 720

Optima™

Optima™ DEEP THORACIC BACK SUPPORT

Optima™ DEEP Fits Width Height $ 3

NOPCB1616 16”-18” 16” 790

NOPCB1619 16”-18” 19” 790

NOPCB1816 18”-20” 16” 790

NOPCB1819 18”-20” 19” 790

NOPCB2016 20”-22” 16” 790

NOPCB2019 20”-22” 19” 790

NOPCB2213 22”-24” 13” 820

NOPCB2216 22”-24” 16” 820

NOPCB2219 22”-24” 19” 820

Optima™ DEEP

Classic™ Fits Width Height $ 3

NACB1616 16”-18” 16” 690NACB1618 16”-18” 18” 690NACB1816 18”-20” 16” 690NACB1818 18”-20” 18” 690NACB1820 18”-20” 20” 690NACB2020 20”-22” 20” 660NACB2216 22”-24” 16” 720NACB2218 22”-24” 18” 720NACB2220 22”-24” 20” 720

Classic™

Classic™ PELVIC BACK SUPPORT Classic™ DEEP PELVIC BACK SUPPORT

Classic DEEP™ Fits Width Height $ 3

NPCB1616 16”-18” 16” 690NPCB1618 16”-18” 18” 690NPCB1818 18”-20” 18” 690NPCB1820 18”-20” 20” 690NPCB2020 20”-22” 20” 690NPCB2216 22”-24” 16” 720NPCB2218 22”-24” 18” 720NPCB2220 22”-24” 20” 720

Classic™ DEEP

ALL PRICES QUOTED IN CDN. PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE.For additional NXT models, sizes and hardware not shown, please refer to the complete NXT Seating Order Form at www.motioncomposites.com

Model #NIB-0784 $ 3 Model # NIB-0818 $ 3

10” x 5” Large Rectangular 195 14” x 5” Extra-Large

Rectangular 195

Model #NIB-0747 $ 3 Model # NIB-0823 $ 3

Multi-Axis Hardware 145 Head Support Receiver Bracket 55

MultiFit™ HEAD SUPPORT – MULTI-ADJUSTABLE PADS MultiFit™ HEAD SUPPORT – FIXTURES

TH

OR

AC

ICS

HA

PE

Xtend™ Fits Width Height $ 3

NHAACB1616/20 16”-18” 16”-20” 690

NHAACB1816/20 18”-20” 16”-20” 690

NHAACB2016/20 20”-22” 16”-20” 690

NHAACB2216/20 22”-24” 16”-20” 720

Xtend™

Xtend™ HEIGHT ADJUSTABLE THORACIC BACK SUPPORT Xtend™ DEEP HEIGHT ADJUSTABLE THORACIC BACK SUPPORT

Xtend™ Fits Width Height $ 3

NHAACB1616/20 16”-18” 16”-20” 690

NHAACB1816/20 18”-20” 16”-20” 690

NHAACB2016/20 20”-22” 16”-20” 690

NHAPCB2216/20 22”-24” 16”-20” 720

Xtend™ DEEP

PE

LV

IC S

HA

PE

BioFit™ Fits Width Depth $ 3

NXCABF2016 19” - 20” 16” 595

NXCABF2018 19”, - 20” 18” 595

NXCABF2020 19” - 20” 20” 625

NXCABF2216 21” - 22” 16” 625

NXCABF2218 21” - 22” 18” 625

NXCABF2220 21” - 22” 20” 625