Order no.: ... Date Signature. The selection of transport wheels excludes the option of an anti-tipper. Additional charge

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1 Otto Bock 647F218=GB 647F204=D Kae Technical modifications and printing errors reserved. DETACH HERE AND SEND BY FAX TO OTTO BOCK q Provide estimate only q Order q Front Frame Type MA 01 MA 02 Order no.: Attachment for custom fabrication enclosed Invoice address / Customer number Delivery address Sales person Seat Measurements [ ] Standard [ ] 2 cm offset Name... Date Signature Avantgarde XXL2 Wheelchair for active use Article number: 480F45=50000 Standard Equipment Aluminum tube frame with double crossbrace Frame offset can be selected Single-panel aluminum footrest Back is adaptable and different height settings are possible Aluminum side panels Swing-away footrest holders Modular design Reinforced hollow rims Wheel lock Folding; max. user weight: 180 kg Frame Accessories MA 50 [ ] Transport wheels MA 55 [ ] Anti-tipper, right MA 51 [ ] Tip-assist, right MA 56 [ ] Anti-tipper, left MA 52 [ ] Tip-assist, left MA 57 [ ] Crutch holder, right The selection of transport wheels excludes the option of an anti-tipper. MA 58 Seat width in cm [ ] 46 [ ] 48 [ ] 50 [ ] 52 [ ] 54 [ ] 56 [ ] 58 [ ] 60 [ ] 62 Seat depth in cm [ ] 40 [ ] 42 [ ] 44 [ ] 46 [ ] 48 [ ] 50 [ ] 52 [ ] 54 [ ] 56 [ ] Crutch holder, left Casters MF 04 [ ] 5.5" soft MF 07 [ ] 7" pneumatic tire MF 09 [ ] 8" pneumatic tire Seat Height Measurements (table on the next page) Anterior seat height in cm... (possible setting range cm) Posterior seat height in cm... (possible setting range cm) The number codes contained in this order form are not intended to be used as article numbers for spare parts orders. For spart parts orders please use the spare parts catalog. Avantgarde XXL 2 /6

2 Information Seat height table Anterior seat height Caster fork, short Pos. 1) Pos. 2) Pos. 3) Pos. 4) Caster diameter 5.5" ) 1) Caster diam. 7", pneum. tire 49 1) 1) 1) Caster diam. 8", pneum. tire 1) 1) 1) 1) Caster fork, long Pos. 1) Pos. 2) Pos. 3) Pos. 4) Caster diameter 5.5" Caster diam. 7", pneum. tire Caster diam. 8", pneum. tire ) 1) Combination not possible The anterior seat height is dependent on the chosen wheel size, caster fork, and mounting position. Please refer to the seat height table! When using a wheelbase extension, deviations of approx. 15mm may occur. Posterior seat height Mounting positions Posterior seat height Rear wheel combinations Hollow rim X X White sidewall tire, 1 3/8" X PU tire, 1 3/8" X X Push ring, aluminum, black, high X X Push ring, aluminum, silver, high X Push ring, aluminum, silver, low X Push ring, rubber-coated, high X X Push ring, stainl. steel, polished, high X X Push ring, stainl. steel, polished, low X Push ring, titanium, polished, high X Top Grip push ring, high X MA 01 Standard front frame MA 02 Offset front frame The Top Grip push ring can only be mounted in "wide" position. 5.5" casters are only possible in combination with quick-release axle. 7" and 8" casters cannot be combined with short caster fork. MF 80 Caster fork, long MG 02 24" hollow rim MG 80 Drum brake MH 05 S-type wheel lock MD 10 Back, different angle settings possible MD 58 Back Stabilizer Avantgarde XXL 2 2/6

3 Fork Length MF 80 [ ] Caster fork, long MF 81 [ ] Caster fork, short Otto Bock 647F218=GB Kae Technical modifications and printing errors reserved. DETACH HERE AND SEND BY FAX TO OTTO BOCK Caster Axle MF 90 [ ] Caster forks with threaded axles MF 91 Rear Wheel Size [ ] Caster forks with quick-release axles MG 02 [ ] 24" MG 03 [ ] 26" Tires MG 30 [ ] White sidewall tire, 1 3/8" MG 35 [ ] PU, 1 3/8" Push Rings MG 50 [ ] Aluminum, black coated, high MG 52 [ ] Aluminum, silver anodized, high MG 53 [ ] Aluminum, silver anodized, low MG 54 [ ] Rubber-coated, high MG 56 [ ] Stainless steel, polished, high MG 57 [ ] Stainless steel, polished, low MG 58 [ ] Titanium, polished, high MG 60 [ ] Top Grip, high MG 70 [ ] Narrow mounting position MG 71 [ ] Wide mounting position Rear Wheel Accessories MG 80 [ ] Rear wheel with drum brake for attendant MG 84 [ ] Silicone push ring cover, 24" MG 87 [ ] High pressure air pump, 14 bar MG 88 [ ] Airman pump Wheel Locks MH 01 [ ] Standard wheel lock MH 02 [ ] Standard wheel lock, short MH 05 [ ] S-type wheel lock MH 06 [ ] Wheel lock for user and attendant Wheel Lock Accessories MH 10 Back Height [ ] Wheel lock lever extension [ ] 25 [ ] 27.5 [ ] 30 [ ] 32.5 [ ] 35 [ ] 37.5 [ ] 40 [ ] 42.5 [ ] 45 [ ] 47.5 [ ] 50 Back System Adjustment range MD 01 [ ] Back, straight [ ] cm [ ] cm [ ] cm MD 10 [ ] Back, differ. angle settings possible [ ] cm [ ] cm [ ] cm Back Upholstery MD 04 [ ] Standard MD 05 [ ] Adaptable Back Upholstery with Zippered Pocket MD 70 [ ] Yes MD 71 [ ] No Avantgarde XXL 2 3/6

4 Information ME 06 Side panel with armrest MB 10 Individual footrests MG 91 Eye Catcher decor MG 92 Flower Power decor MG 93 Clown decor MG 94 Fire decor With the combination side panel, adjustable, with protection against cold as well as clothing protector, adjustable, with protection against cold, an asymmetrically spoked drum brake wheel is used, which allows for a better mounting position. The wheel lock lever extension cannot be combined with standard wheel lock, short, and S-type wheel lock. Back upholstery with zippered pocket is not available as standard upholstery. The standard back MD04 can only be combined with push handles, short, MD50, long, MD51, and telescoping, MD53. The back upholstery with spacer fabric ist not available as standard upholstery. For headrests, supports, firm seat and back systems, as well as other accessories, please refer to our Wheelchair Accessories Catalog. Please take also note of our offer of wheelchair seat cushions, see separate order form. Avantgarde XXL 2 4/6

5 Back Upholstery with Spacer Fabric MD 72 [ ] Yes MD 73 [ ] No Otto Bock 647F218=GB Kae Technical modifications and printing errors reserved. DETACH HERE AND SEND BY FAX TO OTTO BOCK Back Accessories MD 21 [ ] Padding for push handles Push Handles MD 50 [ ] Standard, short MD 51 [ ] Standard, long MD 52 [ ] Telescoping MD 55 [ ] Height adjustable / detachable MD 58 [ ] Back stabilizer for MD51 or MD52 Side Panels ME 01 [ ] Adjustable, with protection against cold ME 02 [ ] Clothing protector, adjustable, with protection against cold ME 05 [ ] Side panel with armrest, short ME 06 [ ] Side panel with armrest, long ME 07 [ ] Side panel with armrest, asymmetric Seat Upholstery MC 13 [ ] Standard upholstery MC 15 [ ] Business seat upholstery Seat MC 01 [ ] Standard seat cushion [ ] 3 cm [ ] 5 cm [ ] 8 cm MC 05 [ ] Evolight seat cushion (thickness 6 cm) Footrest Setting Lower leg length in cm... (possible setting range cm) Seat cushion thickness in cm... (without indication: factory presetting of 5 cm) Footrests MB 01 [ ] Single-panel footrest, angle adjustable, footplate 12.5 cm long MB 03 [ ] Single-panel footrest, angle adjustable, footplate 16 cm long MB 10 [ ] Individual footrests, angle adjustable, footplate 16 cm long Footrest Accessories MB 70 [ ] Locking device for single-panel footrest MB 72 [ ] Heel band for individual footrests MB 73 [ ] Adjustable lateral heel blocks Other Accessories MZ 51 [ ] Lap belt with metal buckle MZ 52 [ ] Tool kit Spoke Protectors MG 90 [ ] Spoke protector, transparent MG 91 [ ] Spoke protector, Eye Catcher decor MG 92 [ ] Spoke protector, Flower Power decor MG 93 [ ] Spoke protector, Clown decor MG 94 [ ] Spoke protector, Fire decor Frame Colors 001 [ ] Brilliant silver 002 [ ] Anthracite metallic 003 [ ] Deep black 004 [ ] Ice-blue 005 [ ] Sparkle light orange 006 [ ] Sparkle blue-green 007 [ ] Sparkle silver new 008 [ ] Snake clear red Avantgarde XXL 2 5/6

6 009 [ ] Dormant vinho sparkle 010 [ ] Dormant marine blue 011 [ ] Dormant apple green 012 [ ] Dormant sky blue 013 [ ] Mystery 014 [ ] Candy red 015 [ ] Clear reptile glossy Upholstery Colors 901 [ ] Black 902 [ ] Blue Special Accessories MZ 93 [ ] Backpack MZ 90 [ ] Tire-A-Light, red MZ 91 [ ] Tire-A-Light, blue Avantgarde XXL 2 6/6