ANTI-THRUST PELVIC HARNESS EE3M

Transcription

1 NTI-THRUST PLVI HRNSS 3M -mail utton Name ompany P.O. # Select Size Size Table Size Small Medium Large X-Large ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO3M /20/12

2 ontour Seating Order iagram Please Note: Measurements are foam only and do not include 1/2 base of marine grade plywood. Name ompany P.O. # oam abric olor L M Rear K ront G H I J ront KL Rear KR Seat Width... Seat epth... nti-thrust epth... bductor epth... Seat Height at Outer Right Leg dge... Seat Height at enter of Right Leg Trough bductor Height... G Seat Height at enter of Left Leg Trough.. H Seat Height at Outer Left Leg dge... I bductor Width... J Seat Height at Rear... K Left Right dductor epth... L dductor Thickness... M or more custom foam combinations and other variations, contact our ustomer Service epartment for assistance. ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SOS /20/12

3 ustom ushion Order orm Name -mail utton ompany P.O. # Retail ustom ushion ase Price $ ustom cushion includes a zippered knit cover as standard, please select color choice. lack or lue Oversized Up harges: MO 1OVR18 ushion over 18 x 18 $ $ MO 1OVR22 ushion over 22 x 22 $ $ MO 1OVR24 ushion over 24 x 24 $ $ ustom oam hart STN10 3# oam in cushion $ per 1 $ HIGH10 4# oamin cushion $ per 1 $ TU10 5# oam in cushion $ per 1 $ UR10 10# oam in cushion $ per 1 $ SUN10 Sunmate oam in cushion soft medium fi rm $ per 1 $ TOM10 T-oam in cushion soft medium fi rm $ per 1 $ PUG10 Pudgee oam in cushion $ per 1 $ R10 ree loat Gel oam* - 18 x 16 & under $ per 1/2 $ R10OVR ree loat Gel oam* - over 18 x 16 $ per 1/2 $ WL10 Waffle ree loat Gel oam - 18 x 16 & under $ per 1/2 $ WL10OVR Waffle ree loat Gel oam - over 18 x 16 $ per 1/2 $ V10 va oam in cushion $ per 1 $ ROHO10-12 ROHO adaptor cushion insert Ischial relief $ per 1 $ ROHO10-13 ROHO adaptor cushion insert occygial relief $ per 1 $ ase Layer to be Middle Layer to be Top Layer to Modifications: Mod-10 Specifi c Width, epth & Thickness Quote $ Mod-10 Upholstery over $ ea. $ Mod-10I Ischial ut-out: 7 wide x 6 deep $ ea. $ Mod-10J occy. ut-out: 3 wide x 4 deep $ ea. $ Mod-10K Wedge ut-out: ront-rear or Left-Right $ ea. $ Mod-10M Pre Ischial ar: 3 wide x 4 deep $ ea. $ Mod-10N Tie $ ea. $ Mod-10O Tabs with Snaps $ pr. $ Mod-10P Sealed Incont. Liner $ ea. $ Mod-10Q Non-Skid ase $ ea. $ Mod-10R Hook & Loop $ ea. $ Mod-10S nti Thrust $ ea. $ Mod-10T ontour, bductor & nti Thrust $ ea. $ Mod-10U ontour, dductor & nti Thrust $ ea. $ Mod-10V ontour, bductor, dductor & nti Thrust $ ea. $ Mod-10W Grid Style over $ ea. $ Mod-10X pplewood ushion ase (14 & under only) $ ea. $ Total $ *ree loat & Waffle ree loat can only be ordered up to 16 x 18 sizes. If you need larger size width or depth, you may ask for pieces to be glued in order to achieve the size needed. Waffle cannot be glued together to create a thicker cushion. Only Standard ree loat can be glued for thickness. Waffl e can be 1/2 thick only. ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO /20/12

4 asy onforming ack - Standard (ustom ack with Trunk and Hip Lateral ontrol) -mail utton ustomer Information: ustomer Name: ealer Name: ity: St. Phone Number: ax Number: -mail ddress: Marked or: Quote to: -mail or ax Wheelchair Specifications: Model: Width: 1. hoose Hardware J s and L s and 4 Glide Locks $ J s and L s and 2 Glide Locks with 2 Split ollars $ asy lamps $1071 Z ON2 2 J s and L s and 2 Glide Locks and Hinges $923 Heavy uty Package (needed when frame is over 20 wide). (actory Quote) 2. hoose Modifications (may choose one or more) Mod-2QQ Split Outer Wings (wings are cut in half as a standard) $205 Mod-2SS Laterals Upholstered Separately foam enter Panel $177 Mod-2UU Wings Molded Together in ront (only one angle of adjustment) $205 Mod-2QPlateMate PlateMate Universal Headrest Plate $ 42 (PlateMate needed when not using reedom headrest) Mod-2S oam-in-place (hoose soft medium) $231 Mod-2cono4 Hardware Upgrade with 4 cono-ze Hardware $149 Mod-2cono2 Hardware Upgrade with 2 cono-ze Hardware $ 50 (needed when using a hinge) 3. hose Upholstery lack Lycra lack artex lack Reverse artex Other (Type and olor) 4. hoose oam (standard foam is 1/2 3# foam with 1/2 soft sunmate overlay) oam ase Layer Overlay 3# oam $ 40 per 1 Soft Sunmate $ 94 per 1 Med. Sunmate $ 94 per 1 Pudgee $222 per 1 Soft T-orm $101 per 1 Med. T-orm $101 per 1 See page 2 for ustom Sizing ROM SIGNS, IN Madera Rd. Simi Valley, ax

5 5. ustom Sizing: Width imensions 11/12 =7 =8 =13 =3 =2 =7 13/14 =9.5 =10.5 =15 =4 =3 =9 15/16 =10.5 =11.5 =17 =4 =3 =11 17/18 =11 =12.5 =19 =4 =3 =13 19/20 =12 =13.5 =21 =4 =3.5 =15 21/22 =13 =14.5 =23 =4 =3.5 =17 23/24 =14 =15.5 =25 =4 =3.5 =19 25/26 =14 =15.5 =27 =4 =3.5 =21 ustom Size hart. Left. Right. Left. Right.. Left. Right. Left. Right. Standard G. * *G is for Mod-2-QQ Split Outer Wing Only G Notes: ROM SIGNS, IN Madera Rd. Simi Valley, ax

6 RGO-JUSTL K -mail utton MOIITION Name MO-2GG* rgo back w/bi-angular cut Retail $376 ea ompany P.O. # abric MO-2HH* rgo back w/o bi-angular cut Retail $270 ea MO-2II* rgo back w/hinges only Retail $325 ea *Solid back must be ordered with this modifi cation. G G ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SOM /20/12

7 Sleek Line 6V reedom orm Vest Name -mail utton ompany P.O. # ross Length Mid Width Mid Length Select Size Size Table Size ross Length Mid Width Mid Length X-Small /4 4 Small /4 Medium /4 Large /4 6 X-Large 23 1/2 1 3/4 7 ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO6V /20/12

8 Hipster Pelvic Positioning elts Name ompany P.O. # Size hart Size Webbing Pad Size Webbing Length X-Small 1 1-1/2 x 4-1/2 46 Small 1 1-3/4 x 6 50 Medium 1-1/2 2-1/2 x 7-1/2 56 Large 2 2-3/4 x 8-1/2 60 X-Large 2 2-3/4 x 9-1/2 66 Two-Point Padded elts Qty. Part # escription heck Size Needed Retail enter Pull Hip-3000 Plastic Push utton uckle XS S M L XL $ 84 ea Hip-3001 Squeeze Release uckle XS S M L XL $ 87 ea Hip-3002 Metal Push utton uckle S M L XL $109 ea Hip Metal Push utton uckle with 3/4 Webbing S M L XL $109 ea Hip-3003 irline uckle M L XL $125 ea Hip-3004 Z Release Push utton uckle XS S M L XL $109 ea ual Pull Hip-3005 Squeeze Release uckle XS S M $ 79 ea Rear Pull Hip-3006 Squeeze Release uckle XS S M $100 ea Hip-3007 Metal Push utton uckle S M $122 ea Hip Metal Push utton uckle with 3/4 Webbing S M L XL $122 ea Hip-3008 Z Release Push utton uckle XS S M L XL $122 ea Hip-3009 Plastic Push utton uckle XS S M L XL $ 95 ea our-point Padded elts enter Pull Hip-3010 Metal Push utton uckle S M L XL $129 ea Hip Metal Push utton uckle with 3/4 Webbing S M L XL $129 ea Hip-3011 irline uckle L XL $149 ea Hip-3012 Z Release Push utton uckle XS S M L XL $129 ea Hip-3013 Plastic Push utton uckle XS S M L XL $119 ea Hip-3014 Plastic Squeeze Release uckle XS S M L XL $122 ea ual Pull Hip-3015 Squeeze Release uckle XS S M L XL $107 ea Rear Pull Hip-3016 Metal Push utton uckle S M $145 ea Hip Metal Push utton uckle with 3/4 Webbing S M $145 ea Hip-3017 Z Release Push utton uckle XS S M L XL $145 ea Hip-3018 Plastic Push utton uckle XS S M L XL $135 ea Hip-3019 Plastic Squeeze Release uckle XS S M L XL $137 ea Non-Padded elts enter Pull Hip-3020 Squeeze Release uckle XS S M L XL $ 48 ea Hip-3021 Metal Push utton uckle M L XL $ 50 ea Hip Metal Push utton uckle with 3/4 Webbing S M $ 50 ea Hip-3022 irline uckle L XL $ 93 ea ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SOHPP mail utton 06/20/12

9 Shoe Holder iagram/order orm xtra Large = 10 Long 5-1/4 Outside Width 4-1/2 Inside Width -mail utton Large = 8 Long 5 Outside Width 4-5/16 Inside Width Name ompany P.O. # Size Pad abric Medium Large = 7-1/4 Long 4-1/4 Outside Width 3-1/2 Inside Width Medium = 6-1/2 Long 4 Outside Width 3-1/4 Inside Width 9 9 9G Shoeholders with Hook & Loop Shoeholders with uckles Shoeholders with uckles & combo Hook & Loop straps Small Medium = 5-3/4 Long 3-3/4 Outside Width 3 Inside Width Small = 5 Long 3-1/2 Outside Width 2-3/4 Inside Width Retail $ per pair ROM SIGNS, IN N. Madera Rd. Simi Valley, ustomer Service Phone: ax: mail: customerservice@freedomdesigns.com SOSH /20/12

10 reedom esigns, Inc. Simply Seating Order orm it! ustomer Information ate: Purchase Order #: ealer / cct. #: Ship to Street: Ship to ity: Ship to State: Ship to Zip ode: Offi ce / Mobile #: Offi ce ax #: -mail ddress: Quote to: -mail ax uyer: Marked or: Seating Specifications ack Height: Lateral Height: Lateral Width: Hip Width (rear): Set Up Seat epth: Hip Width (front): G + 3 for Growth: H Seat Width: I ack Width: Important Note: To ensure quote accuracy, seat and back width, depth and height dimensions must be provided. Seats and backs over 18 in width, depth or height are subject to oversize charges. inished imensions Standard cut is oltaron with foam rolled over edge. I G H reedom esigns Upholstery Selections 1. hoose ontact / Non-ontact 2. hoose Upholstery 3. hoose omponent ody ontact Surface ravo Silver nti-microbial Upholstery hoose Standard in lack Only hoose Reversed in lack Only ushioned irmesh reathable Upholstery hoose Standard hoose Incontinence Resistance Liner Other Upholstery Options Number: hoose ody Non-ontact Surface ravo Standard Upholstery hoose Standard in lack Only hoose Reversed in lack Only ushioned irmesh reathable Upholstery hoose Standard hoose Incontinence Resistance Liner Other Upholstery Options Number: hoose Monogram Option Name: Script lock Thread olor: mbroidery Option esign: Seat ase ack ase Headrest Pad Lateral Pads Hip & Knee Pads When ordering choose either Monogram or mbroidery Note: reedom s NW RVO SILVR fabric is another important step we have taken to help keep our kids healthy. n NTI-MIROIL fabric, RVO SILVR utilizes SILVR THNOLOGY to create a barrier to help control bacterial growth on contact. RVO SILVR is also latex free, highly incontinence resistant, fi re retardant and approved. Similar to artex, all RVO upholstery has a standard surface or can be reversed for easy cleaning. reedom s ushioned irmesh fabric is designed to be used primarily on back support surfaces. onded to irmesh fabric is a thin layer of reticulated foam. s the body moves the foam expands and contracts under pressure from movement. ir is circulated through the irmesh upholstery to ventilate the back to help cool the body. Wheelchair Specifications Model: Width: epth: reedom Install Program Purchase Order #: of frame for install reedom Install Program does not include power wheelchairs N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 1

11 reedom esigns, Inc. Simply Seating Order orm Seat (2609) Marked for Step 1. 1-Kit (Seat) $ Simply Seating Seat Kit Includes: oltaron planar / fl at base 1/2 thick up to 18 x 18 size ut full width 2 x 2 back post notches oltaron T nutted for tracks, hinge and medial thigh support ase sizes larger than 18 x 18 subject to oversize charge Tracks for hardware and accessory attachment ase attachment hardware Seat to back hinge 1 1/2 4 lb. foam is standard 3 sided zipper enclosed cover hoose Hardware Option Note: Hinged seat hardware choice must match hinged back hardware choice ( -, -, etc) Kit - Two Point ttachment & Seat to ack Hinge (crash test approved) luminum ast lamp Hardwarere Short L rackets 2 - SZ Select Z rame lamps luminum 30 egree lamps Note: hoose 1 Seat to ack Hinge Option from 1 - XT - Kit - Two Point ttachment & Seat to ack Hinge (crash test approved) Z LIT XTN Snap ttachment Hardware 2 - SZ Select Z rame lamps luminum 30 egree lamps Note: hoose 1 Seat to ack Hinge Option from Kit - our Point ttachment with NO Seat to ack Hinge (crash test approved) luminum ast lamp Hardware Short L rackets 2 - SZ Select Z rame lamps 1- Knob - Kit - Two Point ttachment & Seat to ack Hinge (crash test approved) 2 - Knob Hardware luminum 30 egree lamps Seat Mount racket Note: hoose 1 Seat to ack Hinge Option from Seat to ack Hinge Options (pair) Seat to ack Hinge lush (pair) Seat to ack Hinge Offset Step 2. hoose ustomization to 1 Seat 1S1K nti-thrust dd $187 1S1Y ontour dd $320 Height of anti-thrust shelf is 1 Leg trough depth is 1 = irst 1/3 of seat set up depth Height of anti-thrust is 1 (see page 1) = irst 1/3 of seat set up depth (see page 1) 1S1R symmetrical - Long Rt. dd $ 78 1S1L symmetrical - Long Lt. dd $ 78 1S1ML 1/2 Maple Laminate ase n/c 1S1WT ase with T-Nuts for Hardware n/c (no tracks included) 1S1 ase Only etween Rails dd $161 1S1G ushion Separate from ase dd $ 94 Part Number Seat onstruction Price 1SSTN1 3 lb oam $ 40 per 1 1SHIGH1 4 lb oam $ 40 per 1 1STU1 5 lb oam $ 42 per 1 1SSUN1S Soft Sunmate $ 73 per 1 1SSUN1M Med Sunmate $ 73 per 1 1STOM1S Soft T oam $ 79 per 1 1STOM1M Med T oam $ 79 per 1 1SPUG1 Pudgee $205 per 1 Note: ottom Thickness Top Thickness Part Number 1SWL1 1S1 Modular ontour dd $424 1S1UU ut, arve, ontour dd $411 1S1L Grid ut dd $296 1S1I Incontinence Resistance Liner dd $ 26 1S1 Incontinence Slip over dd $200 1SWL1OVR 1SR1 1SR1OVR Note: Seat Price onstruction Waffl e 1 $240 per 1/2 (up to 18 x 16 ) Waffl e 1 Over $481 per 1/2 (over 18 x 16 ) ree 1 $301 per 1/2 (up to 18 x 16 ) ree 1 Over $601 per 1/2 (over 18 x 16 ) ottom Thickness Top Thickness 2241 N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 2

12 2 - Kit - Two point ttachment & Seat to ack Hinge (crash test approved) Plastic ast lamp Hardware Long L rackets 2 - SZ Select Z rame lamps Note: hoose 1 Strap Riser (pair) from reedom esigns, Inc. Simply Seating Order orm ack (2617) Marked for Step 1. 2-Kit (ack) $ Simply Seating 2 ack Kit Includes: oltaron planar / flat base 1/2 thick up to 18 x 18 size ut between rails unless otherwise specified oltaron T nutted for tracks, hinge and headrest plate ase sizes larger than 18 x 18 subject to oversize charge Tracks for hardware and accessory attachment ase attachment hardware Headrest adapt-a-plate nterior trunk support strap risers Up to 18 x 18 x 1 4 lb. foam 3 sided zipper enclosed cover hoose Hardware Option Note: Hinged back hardware choice must match hinged seat hardware choice ( -, -, etc). 2 (2 pt mount) 22L iangular ut / ual overs dd $ djustable Lumbar dd $266 22L iangular ut / Single over dd $270 G H G J J H Part Number 2WL2 2WL2OVR 2R2 2R2OVR Notes: ack onstruction 2241 N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page Knob - Kit - Two Point ttachment & Seat to ack Hinge (crash test approved) 2 - Knob Hardware ack Mount racket Note: hoose 1 Strap Riser (pair) from Kit - our Point ttachment with NO Seat to ack Hinge (crash test approved) Strap Riser hoices (choose 1 pair) Plastic ast lamp Hardware 2 - Mod-6 1 1/2 Wide Strap Opening lat Long L rackets 2 - Mod Wide Strap Opening lat 2- SZ Select Z rame lamps 2 - Mod-6 1 1/2 Wide Strap Opening 25º ack end Note: hoose 1 Strap Riser (pair) from Mod Wide Strap Opening 25º ack end (4 pt mount) Step 2. hoose ustomization to 2 ack 22I urved ase dd $119 22H I-ut ase dd $114 22I urved oam dd $103 22J T-ut ase dd $114 I-ut ase T-ut ase 22ML 1/2 Maple Laminate ase n/c 22WT ase with T-Nuts for Hardware n/c (no tracks included) 22GG rgo djustable dd $376 22K Grid ut (when combined with dd $296 22, grid is above lumbar only) Part Number ack onstruction Price 2STN2 3 lb oam $ 40 per 1 2HIGH2 4 lb oam $ 40 per 1 2TU2 5 lb oam $ 55 per 1 2SUN2S Soft Sunmate $ 94 per 1 2SUN2M Med Sunmate $ 94 per 1 2TOM2S Soft T oam $101 per 1 2TOM2M Med T oam $101 per 1 2PUG2 Pudgee $222 per 1 Note: ottom Thickness Top Thickness 22S ree orm ase Soft ox dd $231 22SM ree orm ase Med ox dd $231 22SG ree orm ase Soft ag dd $231 22S1 Liquid Sunmate ox Kit Soft dd $215 22S1M Liquid Sunmate ox Kit Med dd $215 22S1G Liquid Sunmate ag Kit Soft dd $231 Price Waffl e 2 $240 [per 1/2 (up to 18 x 16 ) Waffl e 2 Over $481 per 1/2 (over 18 x 16 ) ree 2 $301 per 1/2 (up to 18 x 16 ) ree 2 Over $601 per 1/2 (over 18 x 16 ) ottom Thickness Top Thickness

13 reedom esigns, Inc. Simply Seating Order orm ccessories Marked for Medial Thigh Support (bductor) 3-2 Lever lip own $414 (push lever down) (0957/1028) 3S Push utton lip own $394 (push button in) (0957/1028) 3P Hide way - Lever lip own $414 (pull lever up) (0957/1028) Standard Small 3L x 3H x 3-2 Taper Medium 4L x 3H x 3-2 Taper Large 5L x 4H x 4-2 Taper X-Large 6L x 5H x 5-3 Taper Hip Guides 4 ixed L-racket (0956) $221/pair Set at hip 4 ixed Offset Hardware (0956) $221/pair Set at knee 4 Quick Release (0956/1028) $443/pair = 4 high or Mod-4 ustom ontour $ 84/pair = Set up seat depth or Trunk Supports 5 ixed L-racket $221/pair (0956) 5 ixed Offset Hardware $221/pair (0956) 5 Lift Swing way $443/pair (0956/1028) 5W NW Push utton Swing way $443/pair (0956/1028) 5P Lever Swing way $497/pair (0956/1028) 5K Lift Swing way Summer Winter $591/pair (0956/1028) 5Q Lever Swing way Summer Winter $625/pair (0956/1028) Mod-5 Protective oot for Hardware $ 50/pair 4L x 3H 5L x 4H 6L x 5H Trunk Supports Std. (1 thick) or Thin (.5 thick) lat or urved Headrest Pads (0955) 7756 hubbie Small 10W x 4H Medium 12W x 5H Large 13.5W x 4.5H $ Low Profi le Small 8.5W x 3.5H Medium 9W x 4H Large 13W x 4H $ Hinge Lock 3-Pc Small 4W x 4H Medium 5W x 4H Large 5W x 5H $ Skinny Small 8W x 4.5H Medium 10W x 4.5H Large 12W x 4.5H $184 Headrest Hardware (1028) 7700 Vertical / Horizontal djustable, Removable $ NW djustze Multi-Position Removable $ lip ack djustable Non-Removable $ Rock and Roll djustable, Removable $ Rock and Roll lip own djustable $394 nkle Supports (K0108) 9- Hi-Tops, ynamic (pair) X-Small Small Medium Large $ Point Hi-Tops, ynamic (pair) X-Small Small Medium Large $166 9H oot and nkle Positioners (pair) X-Small Small Medium Large (ankle circumference range) ( ) ( ) ( ) ( ) $206 Shoe Holders (K0108) 9 Shoe Holders - Velcro S S/M M M/L L XL $163 9 Shoe Holders - uckle S S/M M M/L L XL $163 9G Shoe Holders - ombo S S/M M M/L L XL (shoe holder length) (5 ) (5.75 ) (6.5 ) (7.25 ) (8 ) (10 ) $163 elts S pt., Z-Release, enter Pull XS S M L XL $ 88 S pt., Z-Release, enter Pull XS S M L XL $108 S pt., Squeeze Release, enter Pull XS S M L XL $ 67 S pt., Metal Push utton, enter Pull XS S M L XL $ N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 4

14 reedom esigns, Inc. Simply Seating Order orm Trays and ootboxes Marked for Trays Z-Lite 1/4 Lexan Tray No Hardware (0950) $ 93 MO-8N Set of 3 Ribs (K0108) $ 47 Wood n/c Lexan n/c luminum n/c 559 Z-Lite djustable hannel Tray Hardware (ea.) Left Side (1028) $ Z-Lite djustable hannel Tray Hardware (ea.) Right Side (1028) $ Z-Lite 1/4 Lexan Tray with djustable hannel Hardware (0950/1028) $ Z-Lite 1/4 Lexan Tray with Ribs and djustable hannel Hardware (0950/1028) $ /8 Lexan Tray No Hardware (0950) $156 MO-8N Set of 3 Ribs (K0108) $ 47 Wood n/c Lexan n/c luminum n/c 454 djustable Knob Release Tray Hardware (ea.) Left Side (1028) $ djustable Knob Release Tray Hardware (ea.) Right Side (1028) $ djustable hannel racket Tray Hardware (ea.) Left Side (1028) $ djustable hannel racket Tray Hardware (ea.) Right Side (1028) $ /8 Lexan Tray with Ribs and djustable Knob Release Hardware (0950/1028) $ /8 Lexan Tray with Ribs and hannel Hardware (0950/1028) $266 MO-8J Rear Stability elt (K0108) (recommended for any tray with channel hardware) $ 38 Tray Size Size escription X-Small wide chair, tray dimensions - 21 wide x 18 deep, body cut out - 10 wide x 7 deep Small wide chair, tray dimensions - 21 wide x 18 deep, body cut out - 12 wide x 7 deep Medium wide chair, tray dimensions - 24 wide x 22 deep, body cut out - 14 wide x 9 deep Large wide chair, tray dimensions - 26 wide x 24 deep, body cut out - 16 wide x 10 deep X-Large wide chair, tray dimensions - 28 wide x 24 deep, body cut out - 18 wide x 10 deep ootbox Individual Leg radles $537 /pair One Piece ootbox $459 /each W W Hanger Mount Hanger Mount ootplate/ootboard Mount ootplate/ootboard Mount H W Width to fi t or H W Width to fi t or W H H Notes: 2241 N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 5

15 reedom esigns, Inc. Simply Seating Order orm nterior hest Supports (0960) Marked for Marked for 6R $161 6S $161 6U $161 Size XXSmall XSmall Small Medium Large XLarge 6V $161 6X $162 Height of Pad () hest Support XXS XS S M L XL 6R S U N/ V N/ X N/ N/ N/ 2241 N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 6

16 reedom Select nterior reedom Trunk Supports esigns, Inc. Simply Seating Order orm reedom esigns, Incorporated 2241 N Madera Road, Simi Valley, phone: fax: e: customerservice@freedomdesigns.com Quote Order Install uyer: o./ccount: Loca on: ontact #: P.O. #: Marked or: ax: mail: NW Marked for Select Standard Select Narrow Select Standard Zipper Select Narrow Zipper reedom Select nterior Trunk Support Order Part Number reedom Select Support imensions Price G SI-6SNZ-S Select Standard Small $ 130 SI-6SNZ-M Select Standard Medium $ 130 SI-6SNZ-L Select Standard Large $ 140 SI-6SNZ-XL Select Standard xtra Large $ 140 SI-6NNZ-M Select Narrow Medium $ 130 SI-6NNZ-L Select Narrow Large $ 140 SI-6NNZ-XL Select Narrow xtra Large $ 140 SI-6SZ-S Select Standard Zipper Small $ 135 SI-6SZ-M Select Standard Zipper Medium $ 135 SI-6SZ-L Select Standard Zipper Large $ 145 SI-6SZ-XL Select Standard Zipper xtra Large $ 145 SI-6NZ-M Select Narrow Zipper Medium $ 135 SI-6NZ-L Select Narrow Zipper Large $ 145 SI-6NZ-XL Select Narrow Zipper xtra Large $ N. Madera Rd. Simi Valley, Phone ax SOSS /14/12 Rev. J Page 7

17 hair Model: hair Width: hair epth: ack Height: Tube Size: Upholstery olor: ontact: Non ontact: mbroidery Options esign: Monogram: Thread: ont: 1/2 $1206 Knob Seat/Knob ack MO-2I $119 urved Wood Seating & Positioning Order orm - Version 1 -mail utton ompany: lient: RTS: P.O. # Quote: YS NO 4 Point Mount rop Hook Seat ack asy lamp Seat ack J/L ollar lamp Seat ack J/L Q Release Seat ack Rotate Hold own Seat ack $418 ea $541 ea $443 ea $562 ea $431 ea Seat and ack Hinged Together with Hardware MO-2H $114 I-MO MO-2 $266 djustable Lumbar I G L MO-2S $231 ree orm H *MO-1II Seat G H I L n/c ZLite1/2 $1043 Snap Seat/Knob ack MO-2I $103 urved oam MO-2J $114 T-MO Packages MO-2GG $376 rgo *1/4 pplewood ase (14 wide & under only) *MO-2KK ack n/c Model 10 - Z-Lite1 / 2 $1520 Planar Seat with 1/2 of Soft Sunmate over 1 of Medium Planar ack with 1 of Soft Sunmate Z-Lite Seat Mount Hardware 2 ack Mount Hardware 5 (Straight) or 5 (Offset) ixed Trunk Laterals with 5 Track & lat Pads lip and old Seat to ack racket MO-1K nti-thrust Seat $187 Thickness imensions On Seats Include oam Only Model 40 - Z-Lite1 / 2 $1979 Mod-1Y ontourseat with 1/2 of Soft Sunmate over 1 of Medium Mod-2I urved Wood ack with 1 of Soft Sunmate Z-Lite Seat Mount Hardware 2 ack Mount Hardware 5 (Straight) or 5 (Offset) ixed Trunk Laterals with 5 Track & lat Pads with Straight rackets lip and old Seat to ack racket Seat Modification Options MO-1R ssymetrical - Long Right $78 M MO-1Y ontour Seat $320 K L G H J G H Layer oam Type Thickness I Top J Middle K ottom L Thickness imensions On Seats Include oam Only M MO-1 Modular ontour ushion $424 I MO-1L ssymetrical - Long Left $78 MO-2H I Mod ack $114 MO-2J T Mod ack $114 ack Modification Options Std. asy onforming $ xt. asy onforming $114 MO-2S $231 ree orm Soft Medium MO-2QQ $205 G Split Wing G MO-2GG $376 urved oam urved Wood G G ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com 06/20/12

18 Seating & Positioning Order orm - Version 1 ompany: lient: RTS: P.O. # Quote: YS NO Headrests - la arte nterior Posture Supports ynamic Static 7700 $128 Vert. & Horz. dj $280 3 Piece Hinged S M L 7701 $298 Multi-djustable 7756 $184 hubbie S M L 7703 $321 all & Socket 7704 $297 Removable 7756-ell $220 hubbie ell S M L Medial Thigh Support Standard Sizes Small 3L x 3H x 3-2 Taper Medium 4L x 3H x 3-2 Taper Large 5L x 4H x 4-2 Taper X-Large 6L x 5H x 5-3 Taper Pad / Hardware Included 7708 $385 Rock & Roll 7757 $133 Low Profi le S M L 7709 $394 lip own 7760 $184 Skinny S M L 6V $161 6S $161 6R $161 6U $161 Lateral Thigh Supports XXSmall XSmall Small Medium Large XLarge Straight 4 $485 1 Offset Knee dductor ontour Pad 2 Offset Small Reverse est fi t Medium Large 3 $232 djust Remove 3-2 $414 lip / djust 3 $414 lip / djust 3P $414 lip own Trunk Supports MO-4 $84 ustom ontour 4/ $221 L-racket (pr) 4 $443 Quick Release (pr) MO-4 $39ea xtension racket oam Options MO-5 $50 5I Tracks $49/pr Standard Thin abric Sleeve oot 3 Single 11 Single 4L x 3H lat urved 5 Single 9 ouble 5L x 4H Sunmate T-oam Other 7 Single 11 ouble 6L x 5H 9 Single 5 $443 Lift / Swing 5 Micro $443 Lift / Swing Micro 5J $375 ixed Summer/Winter 5P $497 Lever/Swing 5P Micro $497 Lever/Swing Micro Lower Leg and oot Supports W Hi-Tops Shoe Holders $163 W Static ynamic 9 9- $109 9 Velcro 9 9- $166 9 uckle S M L S M L H Trays 5Q $625 Lever Summer/Winter 5S $625 Lever Summer/Winter MO-5J $39ea xtension racket W W W H H $537 H $459 Leg radles oot ox /8" Lexan Tray - No Hardware $ /4 Lexan Tray - No Hardware $ Lexan Tray - dj. Knob Release/ Ribs $215 MO-8J Stability elt $ 38 ea Z-Lite Lexan Tray - 1/4 Thick $167 MO-8K lbow locks $232 pr Z-Lite Lexan Tray with Ribs $ Knob Release $ 50 ea Lexan Tray / 1 Locking Hooks $ Toggle Release $121 ea. 461 hannel racket $ 65 ea. ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com 06/20/12 SOSPV

19 Seating & Positioning Order orm - Version 2 -mail utton ompany: lient: RTS: P.O. # Quote: YS NO Supine Sitting Supine Left Right Left Right ge Weight HL HL 6 HR 4 Head ircumference HR oot Size: L x W 7 I G inished imensions * Standard ut is wood with foam rolled over H G H I hair Make hair epth hair Width hair ack Height Upholstery olor ontact Non ontact Top ottom ack Rail Tube Size ack ront Seat Rail Tube Size back front Solid Seat Note: dimension includes foam only back Seat with Notches front back front I-Mod on Seat back back Laterally Split Seat front G G front *Seat with Wedge *Thickness imensions On Seats Include oam Only back front symmetrical - Long Left ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com 06/20/12 *nti-thrust Seat K back L symmetrical - Long Right front *ontoured Seat M G H J I G H I J K L M

20 Seating & Positioning Order orm - Version 2 -mail utton ompany: P.O. # Monogram Thread olor Script Print Std. ack T-Mod ack I-Mod ack urved ack & imensions are for Scapular utouts = epth of utout ack with djustable Lumbar iangular ack Medial Thigh Support Lateral Thigh Guides Lateral Thoracic Support 3 Piece Headrest Pads rmrest - Thigh Support ombo Standard Thin urved lat Tray / Lapboards Headrest xtension W W 2 Pc.Single Leg radles 1 Pc. ouble Leg ox rm Trough H H W W H 2 Pc. Single 1 Pc. ouble ROM SIGNS, IN N. Madera Rd. Simi Valley, ax SOSPV customerservice@freedomdesigns.com 06/20/12

21 Sleek Line 6U Tapered Vest -mail utton Name ompany P.O. # Select Size Size Table Size X-Small / /2 3 3/4 Small 4 3/ /2 4 1/2 Medium /4 3 1/2 9 5 Large 5 1/2 12 1/2 5 1/ /4 X-Large 6 1/4 14 1/2 5 1/2 10 1/2 6 1/2 ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO6U /20/12

22 Streamline Pelvic Positioning elts Name ompany P.O. # Size hart Size Webbing Pad Size Webbing Length X-Small 1 1-1/2 x 4-1/2 46 Small 1 1-3/4 x 6 50 Medium 1-1/2 2-1/2 x 7-1/2 56 Large 2 2-3/4 x 8-1/2 60 X-Large 2 2-3/4 x 9-1/2 66 Two-Point Padded elts Qty. Part # escription heck Size Needed Retail enter Pull S-3330 Plastic Push utton uckle XS S M L XL $ 62 ea S-3331 Squeeze Release uckle XS S M L XL $ 67 ea S-3332 Metal Push utton uckle S M L XL $ 88 ea S Metal Push utton uckle with 3/4 Webbing S M L $ 88 ea S-3333 irline uckle M L XL $104 ea S-3334 Z Release Push utton uckle XS S M L XL $ 88 ea ual Pull S-3340 Squeeze Release uckle XS S M $ 58 ea Rear Pull S-3350 Squeeze Release uckle XS S M $ 79 ea S-3351 Metal Push utton uckle S M $ 101 ea S Metal Push utton uckle with 3/4 Webbing S M L XL $ 101 ea S-3352 Z Release Push utton uckle XS S M L XL $ 101 ea S-3353 Plastic Push utton uckle XS S M L XL $ 74 ea our-point Padded elts enter Pull S-3360 Metal Push utton uckle S M L XL $108 ea S Metal Push utton uckle with 3/4 Webbing S M L XL $108 ea S-3361 irline uckle L XL $128 ea S-3362 Z Release Push utton uckle XS S M L XL $108 ea S-3363 Plastic Push utton uckle XS S M L XL $ 99 ea S-3364 Plastic Squeeze Release uckle XS S M L XL $101 ea ual Pull S-3370 Squeeze Release uckle XS S M L XL $ 86 ea Rear Pull S-3380 Metal Push utton uckle S M $124 ea S Metal Push utton uckle with 3/4 Webbing S M $124 ea S-3381 Z Release Push utton uckle XS S M L XL $124 ea S-3382 Plastic Push utton uckle XS S M L XL $114 ea S-3383 Plastic Squeeze Release uckle XS S M L XL $116 ea Non-Padded elts enter Pull S-3400 Squeeze Release uckle XS S M L XL $ 27 ea S-3410 Metal Push utton uckle M L XL $ 29 ea S Metal Push utton uckle with 3/4 Webbing M L XL $ 29 ea S-3420 irline uckle L XL $ 72 ea S-3430 Z Release Push utton uckle XS S M L $ 30 ea ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SOSPP mail utton 06/20/12

23 Sleek Line 6S X-hest Vest -mail utton Name ompany P.O. # ross Length Mid Width Mid Length Select Size Size Table Size ross Length Mid Width Mid Length XX-Small /4 3 1/2 X-Small /4 4 Small /2 4 1/2 Medium /2 5 Large /2 X-Large /4 ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO6S /20/12

24 Sleek Line 6R Thoracic Support Vest Name -mail utton ompany P.O. # Select Size Size Table Size XX-Small /2 4 1/2 X-Small /2 3 1/2 7 3/4 5 1/2 Small 6 1/4 17 1/4 4 1/4 8 3/4 6 Medium 7 1/4 18 1/2 5 1/ Large /4 11 1/2 8 X-Large 8 1/2 21 1/2 6 3/ /2 ROM SIGNS, IN N. Madera Rd. Simi Valley, ax customerservice@freedomdesigns.com SO6R /20/12