EIF6, October 2018

PV: PC:( ) Fax: ( )

PV: PC: ( ) Fax: ( )

See Seat Height Matrix on page 2For 14" sizes use E1236

Frame Depths equals Seat Depths.

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

Dealer Phone:Ship To City:

Standard Frame

Seat Depth

14" NC196W7

196W10

196SL6

196W11

Transit

Dealer Address:

Fax

$363.00

Omit Seat Sling -$20.00

196W6

$276.00

196W8

Quickie QXi (Adjustable Axle) 265 lbs

196W9

$2,435.00

18" NC19"

196SL1

196QC03

196JC20

$276.00

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

196SD716" NC

JAY Cushions (Optional)

$276.0020"

196SD10

15"15"

2. SIZE / SEATING

NC

17"

NC

Transit System WC19

196W5 14" NC

196FS30

Option # Option #

Quickie QXiAADL

Dealer Acct #:

Mark For:Date:

Quote Order

Ship To:

PO#:

Submitting for:

Dealer:

Dealer City:

Confirmation Email:

1. FRAME

Attention:

Frame Width

Confirm Via:

Address:

ADDITIONAL SHIPPING INFORMATIONDealer Contact:

196WM78

Base Model

NC

Address:

17"18"19"

Width:

20"

Cushion Name or Part #

NCSeat Sling

196QC02

Price

Email Ship To Phone:

Definition

Hemi Frame196FS9

Price

Frame Style

NC

196TO38

Definition

NC

NC

NC

$276.00

16"

196SD13

NC

Made-to-Order Seating196QC01 Surefit NC

NC196SD11

Standard Seat Sling

NC

196SD71

196SD9 196SD8

Depth:ConfigurfitJayFit

Price ListJAY Bundled Cushion

ORDER INFORMATION: Customer Service: 800-263-3390 Fax: 800-561-5834 www.sunrisemedical.caSpecifications are subject to change without notice. Copyright © 2018 Sunrise Medical Canada Inc. MK-100025 Quickie QXi REV F

Page 1

Quickie QXi featuring the Jay ION™ cushionQuickie QXi, Ultra Lightweight Adjustable Folding Wheelchair

12.5" & 13" only available w/ Alum Angle Adj Footplate NC NC NC NC NC NC NC NC NC NC NC NC NC NC

NC

See Rear Seat Height Matrix See Rear Tire & Wheel Matrix for availability

See Rear Tire & Wheel Matrix for availability Natural Fit only available w/ 22, 24, 25 Lite Spoke. Plastic NA w/ 25, 26" See Apendix for Rear wheel / Handrim matrix

196RW94

24" Mag Wheel 5 Spoke

196SH23

-$43.00

Aluminum Anodized

196HR26

196RW25

22" Mag Wheel 5 Spoke

$389.00

$113.00

196HR32

196RW103

Hemi Frame12.0" - 15.0"

196RW93

196RW90

Omit26" Lite Spoke Wheel

22" Mag Wheel

25" Lite Spoke Wheel NC

20" Mag Wheel

Natural Fit - Standard GripNC

196HR23196HR22

Rear Wheel Size

196HR1

196RW8NC

14.0" - 17.5"26" Rear Wheel 16.0" - 19.5"

15.5" - 19.0"

NC

NCNC 14.5" - 18.0"

13.0" - 16.5"22" Rear Wheel

196RH15

Schwalbe Marathon Plus Evolution

196RT39

24" Lite Spoke Wheel NC

13.5" - 17.0"

196RT21

NC

24" Rear Wheel 15.0" - 18.5"25" Rear Wheel

High-Pressure Clincher Black

196RH26

19"

196RH11

196RH18

196RH27

196RH17

196RW1

20" Lite Spoke Wheel $286.00

20" Mag Wheel 5 Spoke

NC

NC

NC

196SH42 14.5"

16.5"

19.0"

8" Polyurethane 8" x 1.5" Semi Pneumatic

13"

196SH17

12.5"

Std Frame

196SH18

14.0" - 17.5"

196RH1615"

Rear Wheel Size

6" x 1.5" Semi Pneumatic

Caster Fork

196SH40

196CW5

196CF17

196CW44

17.0" Front Seat Height Matrix

NC196SH14196SH35

12.5"196SH15196SH16

196SH34

196CS1

1 1/2"196CS5

NCNC

NC

196HR28

NC15.5"

7"

18.0"

196CS9

Caster Stem Bolt

16"

$286.00

196RT3

16.5" Pneumatic

NC

196HR27

NC

NC18"

NC

18.5"

196RW102

Seat Squeeze Matrix

22" Lite Spoke Wheel196RW91

NC

$141.00

196RH19 17"

196RW3

196RH21

196RW92

Natural Fit - Super Grip$346.00

$422.00

196RH20

NC

196RW104 196HR4

Handrim

24" Mag Wheel

NC

17.5"

Rear Seat Height Matrix

12"

196CF12

196CW34196CW35

NC

NC

196CW39

20" Rear Wheel

14"

196CW32

NC

196CF23

Rear Seat Height

$221.00NC

Pneumatic w/ Airless Insert

14.5" Rear Wheel Tire

196RT1

196RT2

3. CASTERS / SEAT HEIGHT

196CW3

Standard3/4"

13.0"

14.0"

16.0"

196RH10

196RH14

12.5" - 16.0"

196RH13

NC

$130.00

5" x 1.5" Semi Pneumatic

17.5"

18.5"

196SH41

NC

$98.00

NC13.5"

NC

NC

4" x 1.25" Semi Pneumatic

Caster Wheels4" Low Profile Polyurethane

3.5" (standard stem bolt only)

196CW76" Polyurethane NC

$93.00

NC

$403.00The Surge LT - Oval w/Gription Strip $488.00

Natural Fit - No Thumb Grip$446.00

Q-Grip Neoprene Coated

The Surge - Oval w/Gription Strip

$130.00

NC

5" Low Profile Polyurethane

196RH9

6"

Plastic

196RH12

196CF715.25"

196SH20

19.5"196SH21

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

196SH12196SH13

15.0"15.5"

Full PolyNC

Front Seat Height

$98.00

4. REAR WHEELS / REAR SEAT HEIGHTS

13.5"

NC

Frame Depth Max Seat Squeeze14" 2.0"

15" - 16" 2.5"17" - 18" 2.5"19" - 20" 3.0"

ORDER INFORMATION: Customer Service: 800-263-3390 Fax: 800-561-5834 www.sunrisemedical.caSpecifications are subject to change without notice. Copyright © 2018 Sunrise Medical Canada Inc. MK-100025 Quickie QXi REV F

Page 2

Measure from front of back post to center of rear axle

Available only with 24" MBL Lite spoke wheels. Std Aluminum black handrim

Right Hand Mount Left Hand Mount

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

Footplate mounts with Extension Tube using clamping hardware See Lower Leg Length Matrix for range

Heel loop not included, see Footplate Option section below

AluminumOnly available w/Elevating Legrest

Adjustable Heel Loop Gel Cover For Hangers (Pair)

Integral Push Handles, Folding Height Adjustable & Omit is 8° for Standard Backrest, Straight for Angle Adj. Backrest

Fixed Sleeve 3⁰Fixed Sleeve 0⁰

NC196CC5

1.5"

196CC6

196CC4 NCNC

$286.00196WL23

Hanger & Footplate Options

$471.00

2.5"

196F3Elevating Hanger - Front MountOnly available w/ front mount alum angle adj footplates and 14"-22" width 206

Aluminum Angle Adj. Footplate

196H145

Threaded Axle

2"

NCAdjustable Axle Options

3"NC

NC

1"

NCNC

Adjustable sleeve

Axle

$163.00

NC

196AX11

$134.00

196AL16

196WL12

196CC3NC196CC2

196AS6196AS5

196H159Articulating Hanger NA w/ Alum Angle Adj Front Mount footplates.

Back Type

70° Swing In/Out Hanger

Extension Handle (Pair) High Mount Pull

Unilateral Wheel Lock RightUnilateral Wheel Lock Left

196HL121968A02

NC

Integral Push Handles

Center of Gravity

NC

196E5 Long

196WL1

196E2196H139

$304.00

Footplate

NC

NC

$141.00

High Mount Push

NC

$157.00 196F271

Elevating Hanger - Ext MountNA w/ Alum Angle Adj Front Mount footplates.

Composite Footplate196F1

Composite Angle Adj (16"-22"w)

80° Swing In/Out Hanger

196B9

$304.00

196H160

196F5

Tall (16"-20")

Omit Hanger & Footplate

196E1NC

NC

Compact

$1,239.00

196WL30

Wheel Lock

196WL24

196H144

196H141

196WL2

Do Not Mount196WL10 Omit Wheel Lock

Front Hangers

$146.00

196BT100

196B5

NC

Quick Release Steel

196AX45

60° Swing In/Out Hanger

196BT10

196H161

Backrest HeightNC

NC

Extension Tubes

MediumShort

$157.00

Quad Quick Release Steel NA on Spoke

NC

One Arm Drive

196HM2 NC196HM1 NC

One Arm Drive Adj. Axle Plate

196AS4

196EH7

$286.00

NC

Extension Handle

Rear Tire & Wheel Matrix

Angle Adjustable Back $319.00

$146.00

Med (13"-17")

-$16.00

$65.00

NC

Folding Push Handle with Ht. Adj. Back

196PH5

5. WHEEL LOCKS

6. HANGERS AND FOOTRESTS

7. BACKREST / SEATING

Push Handles

Fold-Down Push Handles Only available with Adjustable Upholstery. Used in combination w/Angle Adjust only avail in 16"-20" back height

$151.00

NC

Standard NC

196PH6

196AX1

4. REAR WHEELS / REAR SEAT HEIGHTS (CONT)

196PH17 $278.00

196PH2 Omit Push Handles

ORDER INFORMATION: Customer Service: 800-263-3390 Fax: 800-561-5834 www.sunrisemedical.caSpecifications are subject to change without notice. Copyright © 2018 Sunrise Medical Canada Inc. MK-100025 Quickie QXi REV F

Page 3

*Reference XXXBU89 for billing

Some limitations when used with the Angle Adjustable Back in the rear most setting Please circle a setting, will default to 11" if no selection is made

9" 10" 11" 12" 13"

Flip Back HA Classic NA w / 14"-15" depth

Armpad - For Height AdjustableArmrest - Padded Swing Away

Back Upholstery

196AA159 Flip Back Ht Adj Classic (11"-15") $341.00Dual Post Flip Back Ht Adj

Side Guards

Purple Heart

Price List

8. ARMREST / SIDEGUARDS

Armrest - Height Adjustable

$304.00

1968A01

$168.00$168.00196SG29

196AM24

$341.00

Armrest OptionsGel Cover For Swing Away Arms (pair)

Plastic - Standard (8.5" High)

196AA65

$141.00

7. BACKREST / SEATING (CONT)

196C113 Titanium Color Paint NC

196C103 Rootbeer NC

Sunrise Orange NC196C145

196C8 Yellow

196C148

NC

Additional Options Through Built for Me

Mauve Pink NC

$330.00

196C114 Sparkle Silver NC

196C108196C144

To inquire about any unique modification for Quickie products, contact: Phone: (800) 263 - 3390, Fax: (800) 561-5834

Electric Blue NCStars & Stripes

Hot Sparkle Pink NCGreen Apple NC

196C147

196C142 Mossy Oak Camouflage 196C43

Zebra (Choose above base color) Std with White unless above base paint is chosen NA w/ Blk, Matte Black, Blk Opal, Titanium)

196C126 Glow NC

Desert Camouflage $330.00NC

$330.00196C143 Evergreen NC 196C42 $330.00

196C35 Candy Red NC 196C112

196C36 Candy Blue196C38 Blue Opal NC

NCNC196C141 Black Cherry

196C10196C152

Matte Electric Blue

Matte Purple

Matte Black Cherry

Matte Evergreen196C150

196C14

NCNC

NC196C2

196AA103

Matte Black

NCNC

Personalized Frame Color

Black Opal

Candy Purple

196C149

NC 196C151

Quickie Clear Spoke Guard

Positioning Belt

196A1

$304.00

Standard Frame Colors Matte Frame Colors

Crutch Holder

1964A02

Aztec Gold NC 196C116 NC196C140

$304.00Single Post Ht Adj - Low (8.25"-12.25")

Black (Not avail as base w/Zebra)

Setting

Anti Tips (Pair)

196A2100

196VU13

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

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

NC

196SG33

196AA14

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

Backpack - Black/Charcoal Adult $100.00Seat Pouch Black $75.00 1968A03

Miscellaneous

NC196AM23

JAY Back (see Order forms)

$81.00

9. KEY OPTIONS

Plastic - Low (6.5" High)

Purple Heart with Air Force Patch

196VU5

NC

$55.00$87.00

JAY Backs

Omit Armrest

1961A01

196A804 Positioning Belt Slide Clamps 1.5" Auto Buckle w/ Clamps196A141

$103.00

NC

196JB01

Pack Accessories

NC

196AA104

196BU71 Backrest Tension Adj 3DX Vented*Reference 186BU71 for billing

$402.00

$249.00

196VU9Backrest Tension Adj EXO

196AA105

Purple Heart with Coast Guard

NC

NC196VU11

Desk Length (10")

Purple Heart with Navy Patch

US Army Patch

NC

NC196VU10

US Air Force Patch196VU4

196VU8

US Coast Guard

Purple Heart with Marines PatchNC

196VU2

$422.00

196BU89

196BU88 Standard Upholstery EXO

Caddy

$146.00

Full Length - Full (14")

US Marines Patch NC

NC

NC

Spoke Guards$108.00 $141.00Quickie Black Spoke Guard

NC

Purple Heart with Army Patch

196VU3

196AT1Anti Tips

1964A01

196VU12

US Navy Patch

NC

10. COLOR

196VU1196BU1 Standard Upholstery Military Service Patches

$67.00

196BU14 Omit Back Upholstery -$20.00

196BU70 Backrest Tension Adj Ballistic Nylon*Reference 186BU70 for billing $379.00

ORDER INFORMATION: Customer Service: 800-263-3390 Fax: 800-561-5834 www.sunrisemedical.caSpecifications are subject to change without notice. Copyright © 2018 Sunrise Medical Canada Inc. MK-100025 Quickie QXi REV F

Page 4

Lower Leg Length Range Matrix

Front Seat Height Matrix Cont.

APPENDIX

ORDER INFORMATION: Customer Service: 800-263-3390 Fax: 800-561-5834 www.sunrisemedical.caSpecifications are subject to change without notice. Copyright © 2018 Sunrise Medical Canada Inc. MK-100025 Quickie QXi REV F

Page 5