Zippie Voyage. April 2013 EIZ14. SHIPPING INFORMATION Dealer Contact:

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1 Zippie Vyge April 2013 EIZ14 Dte: Deler Acct #: Qute Order Deler: SHIPPING INFMATION Deler Cntct: PO#: Deler Address: Ship T: Deler City: ST: ZIP: Attentin: Deler Phne: ( ) Fx: ( ) Address: Address: Cnfirm Vi: Emil Fx Ship T City: ST: Ship T Phne: ( ) Fx: ( ) ZIP: Cnfirmtin Emil: Mrk Fr: DOB (Dte f Birth): mn/dd/yr / / Designed in cnj unctin with Bby Jgger llwing their ptented quick fld technlgy which llws ne t fld bse unit fter remv ing the set in ne simple step nd with secure fld ltch fr esy strge. Ech unit includes: shnd perted Wheel Lck squick relese Frnt nd rer wheels s45 Tilt s12" rer tires & lt. weight frnt wheels stelescping strller hndle sfwd & Rwd fcing seting cpbility sfrnt cster suspensin & swivel lcks sadjustble seting Shell sunder crrige strge scnpy w/ brethble windw/mesh pckets (my be limited when sme ptins chsen) The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price Vyge (Weight Cpcity 60#) 1. FRAME STYLE 198BS7 E1232 Vyge with Tllt Includes Slid Set nd Bck $2, BS8 E1234 Vyge with Tilt Set nd Bck nt included $2, BASE OPTIONS (Vent try ptins in ccessry sectin) 198KJ9 E1014 Recline Feture ( rnge) $ COLS WC-19 Trnsit Optin (includes H Hrness) $ KJ10 Clr Optins - Slid Custm Optin (Only v ilble with Prints) Slid Clrs 198C001 Custm Clr Selectin: Chse & 198CL9 Purple Enter frm Slid Clr Optins: 198CL20 Pink Srbet 198CL11 198CL12 Green Nvy Blue Cnpy Pttern 198CL13 Ornge 198UF01 Crss Over 198CL17 Turquise 198UF02 Center Stripe 198CL16 Blck 198CL18 Burgundy Clr Optins - Print (Std. Trim listed behind ech print) 198CL19 Leprd (Std w/ Blck Trim) 198CL14 Butterflies (Std w/purple Trim) 198CL15 Red Rce Flgs (Std w/ Red Trim) Crss Ov er Center Stripe Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 1

2 The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price 4. SEATOPTIONS (Depth dj ustble frm 5" - 13" with 1" bckrest) Chse sectin A (when rdering bse with set/bck) r B. (when rdering bse withut set/bck) Sectin A. (set ptins when bse with set/bck is rdered) STANDARD includes: - Cntured Medium Density Fm - 6" t 13" Hip Width - 3" Lterl Hip Blcks Nt vil.n w/ Hip Blck ptin - Slight Medil Thigh Cntur - Fixed Ischil Ledge -Built in Depth Grwth - Remvble Neprene Cver ADJUSTABLE CONTOUR SEATincludes: -Adjustble Pre-Ischil Ledge - Adjustble 1" High Fm Wedges fr: Lterl Hip nd Thigh Supprt Medil Knee nd Thigh Supprt - 3" Set Depth Grwth Kit - Remvble Neprene Cver 198CU28 E2292 Stndrd Plnr Set 198ST65 E2294 Adjustble Cntur Set w/ Hip Blcks 198CU41 E2292 Stndrd Plnr Set w/ Hip Blck (Pr) 198CU42 E2294 Cntured Wedge Set Cntured Anti Thrust 198CU43 E2294 (Ledge) Set Chse Fm Sft Fm 198FM2 Medium/Sft Fm 198FM3 Medium Fm $ FM1 Chse Depth Chse Depth Shrt 5" - 8" Depth 198SD78 198SD78 Shrt 5" - 8" 198SD79 Medium 7" thrugh 10" Depth 198SD79 Medium 7" thrugh 10" 198SD80 Lng 9" thrugh 13" Depth 198SD80 Lng 9" thrugh 13" (4" grwth) Sectin B. (set ptins when bse rdered withut stndrd set/bck) STANDARD includes: - Cntured Medium Density Fm - 6" t 13" Hip Width - 3" Lterl Hip Blcks Nt vil.n w/ Hip Blck ptin - Slight Medil Thigh Cntur - Fixed Ischil Ledge -Built in Depth Grwth - Remvble Neprene Cver ADJUSTABLE CONTOUR SEATincludes: -Adjustble Pre-Ischil Ledge - Adjustble 1" High Fm Wedges fr: Lterl Hip nd Thigh Supprt Medil Knee nd Thigh Supprt - 3" Set Depth Grwth Kit - Remvble Neprene Cver 198CU39 198CU44 E2292 E2292 Stndrd Plnr Set w/ Hip Blcks Stndrd Plnr Set w/ Hip Blcks(Pr) $ Chse Fm 198ST60 $ E CU37 E2294 Cntured Wedge Set $ FM1 Sft Fm 198CU38 E2294 Cntured Anti Thrust (Ledge) Set $ FM2 198FM3 Medium/Sft Fm Medium Fm Chse Depth Chse Depth 198SD78 Shrt 5" - 8" Depth 198SD78 198SD79 Medium 7" thrugh 10" Depth 198SD79 198SD80 Lng 9" thrugh 13" Depth 198SD80 Shrt 5" - 8" Medium 7" thrugh 10" Lng 9" thrugh 13" (4" grwth) Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 2

3 The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price 5. BACKRESTSHELL Desired Bckrest Height Setting (Bld indictes defult, when nt picked) 198BT111 Shrt 7" t 13" Height 7" 8" 9" 10" 11" 12" 13" Tll 10" t 17" Height 198BT112 10" 11" 12" 13" 14" 15" 16" 17" 6. BACK OPTIONS Chse sectin A (when rdering bse with set/bck) r B. (when rdering bse withut set/bck) Sectin A. (Bckrest ptins when bse with set/bck is rdered) " T " Bck 1" Thick " T " Bck 2.5" Thick 198BT35 E2291 Shrt 8" t 10" 2.5" "T" Bck is used fr set depths s smll s 3.5", bckrest hs remvble fm fr dditinl depth 198BT28 E2291 Medium 10" t 12" grwth withut djusting set pn. 198BT29 E2291 Tll 12" t 14" 198BT56 Extr Tll 14" t 16" (n/ w Shrt E2291 Bckrest Shell) Sectin B. (Bckrest ptins when bse rdered withut stndrd set/bck) " T " Bck 1" Thick 198BT103 E2291 Shrt 8" t 10" $ BT104 E2291 Medium 10" t 12" $ BT105 E2291 Tll 12" t 14" $ Extr Tll 14" t 16" (n/ w Shrt 198BT106 E2291 Bckrest Shell) $ BT115 E2291 Shrt 8" t 10" 198BT116 E2291 Medium 10" t 12" 198BT117 E2291 Tll 12" t 14" Extr Tll 14" t 16" (n/ w Shrt 198BT118 E2291 Bckrest Shell) " T " Bck 2.5" Thick 2.5" "T" Bck used fr shrt set depths less thn 7.5" nd lng set depths less thn 9.5" 198BT107 E2291 Shrt 8" t 10" 198BT BT109 E2291 E2291 Medium 10" t 12" Tll 12" t 14" 198BT110 E2291 Extr Tll 14" t 16" (n/ w Shrt Bckrest Shell) 7. HEAD SUPPTOPTIONS (Hrdwre llws the hedrest t be flushmunted t bckrest when bv e shell) When chsing hedrest, Hrdwre Brcket must be chsen s well 198HE40 E0955 Whitmyer 8" Plush 198HE29 E0955 Whitmyer Sm Adjust--Plush $ E HE42 E0955 Whitmyer 10" Plush Whitmyer DFS(Frehed Strp) Whitmyer SM Cntur Crdle 198HE43 E0955 Whitmyer Med Cntur Crdle 198HQ6 K HE41 Squred fr Single pd, must rder Whitmyer hedrest $ HE31 E1028 Hrdwre Brcket Only (cn be chsen w/ hedrest) $ FOOTREST 198F312 K0040 Angle Adj. Ftrest (Required) $ Ftrest djustment rnge 1.5" - 12", Shrt Rnge, the ftplte will be inverted. Chse desired setting, if nt chsen Lng rnge is defult. 198F313 K0037 Preset in shrt rnge 1.5"-4" 198F314 Preset in lng rnge 4.5" - 12" Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 3

4 The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price 9. SUPPTS Lterls Height Adjustment Rnge bsed n Bckrest shell height chsen in Sec. 5. i.e. Shrt Height Lts dj. 3" - 12", Medium Height Lts Adj. 3" - 17" Fr the supprts, Vyge will be set up t fctry, insert dimensins n lst pge spec drwing. Nt required, will defult t std. settings * Priced s ech, selecting these ptins indictes Qty 2. Hrdwre Brcket must be chsen with Medil Supprt s pir. Lterl Hip Supprt Lterl Trunk Supprt 198KC4/6 198KC3/5 Nt vilble with stndrd set with Hip Blcks. SM (4" x 4", 3/8" thick)* LG (5.38" x 4 3/4", 1/2" thick)* 198KE25/24 198KD15/19 198KD13/17 Fixed Angle Adjustble* Lrge Stright Pd 3" x 6"* Smll Stright Pd 2" x 6"* 198KF4/6 Nt vilble with stndrd Set with Hip Blcks. Lterl Thigh Supprt SM (4" x 4", 3/8" thick)* LG (5.38" x 4 3/4", 1/2" thick)* 198KF3/5 198KE42/41 198KD15/19 198KD16/20 198KD13/17 198KD14/18 E1028 Swing Awy* Lrge Stright Pd 3" x 6" Lrge Curved Pd 3" x 6" Smll Stright Pd 2" x 6" Smll Curved Pd 2" x 6" Medil Supprt 198KH12 E0957 SM (3"H x 2.5"W x 4.5"L) $ KH13 E0957 LG ( 3 3/4"H x 4"W x 6"L) $ HE77 E1028 Hrdwre Medil Supprt Brkt 10. POSITIONING AND TRUNK SUPPTS Pelv ic Psitining Belt Anterir Trunk Butterfly Supprt Must use when rdering Anterir Trunk Supprts. Dimensins re set t shulder height. 198A14 E0978 1" Pdded $ KI1 XX Smll Butterfly Pd (< 10") 198A15 E " Pdded $ KI2 X Smll Butterfly Pd (10" - 12") 198A263 E0978 1" Pdded Aut Style $ KI3 Smll Butterfly Pd (12" - 14") 198A256 E " Pdded Aut Style $ KI4 Medium Butterfly Pd (14" - 16") 198A818 E0978 Cmfrt Fit APB5145 XS Pd $ KI5 Lrge Butterfly Pd (>16") 198A819 E0978 Cmfrt Fit APB5146 Sm Pd $95.00 Trunk Supprt Optins Cmfrt Fit ATS (Lil Kidds) 198SS1 Shulder Strp Pds $ A820 Cm Fit ATS9107 xxs 9.5 pd $ A821 Cm Fit ATS9100 xs 12.5" pd $ Anterir Trunk H Strp Supprt (included with Trnsit) 198A822 Cm Fit ATS9101 sm 15"pd $ SS2 XX Smll H Strp 5 Pint $ WHEELS AND CASTERS Stndrd re Quick relese rer nd frnt wheels, nd frnt wheel suspensin with cster swivel lcks 198WQ07 K0040 E " Pnuemtic w/ Airless Inserts with 7" csters STD Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 4

5 The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price 12. ACCESSIES (See Av ilble Pictures Belw) She Hlders 198A68 E0952 6" Lng She Hlders $ E A69 E0952 8" Lng She Hlders $ E0951 Ft Strps 198A79 E " Ft Strps with Cvers $ LF2 E A80 E " Ft strps with Cvers $35.00 Try (limit 50#, idel fr U1 r Grp 22 Btteries) includes 1 Utility hk Upper Extremity Supprt Try (Angle Adj ustble Hrdwre Included) (Try Munt djusts frm 4.5"-7.5" with 1" tll cushin ) 198A91 E A92 E LF5 Light Grey $ Cler Ply $ Misc Accessries Cup Hlder/ Bttle/Feeding $ LF1 E LF11 E LF7 Utility Hk (i.e.suctin cnister) $ A74 K0105 IV Supprt Ple 198A462 Rin Cpe $ A713 E2208 O2 Tnk Hlder Accessries Dvetil Verticl Frme Munted Hrdwre fr LTV ventiltrs (limit 15#) includes 1 Utility hk Dvetil Verticl Frme Munted Hrdwre fr Trilgy ventiltrs (limit 15#) includes 1 Utility hk Bttery nd Vent/Utility Underfrme 198LF3 E1029 Frnt munt utility pltfrm (limit 50#) 198LF4 E1029 Rer dd n ccessry pltfrm (limit 45# r ne Grp 24 bttery) includes 1 Utility hk. Must be remved r flded befre flding bse $ $ $ $ $ $ $ A78 E1399 Flr Sitter/ Feeder Bse Flding Bster Bse (Ht. Adj.) $ A714 K0105 E2208 IV/O2 Cmbintin $ IV Supprt Ple Frnt Munt Utility Pltfrm Cup Hlder Upper Extremity Supprt Try Util Bttery nd Vent/Utility Underfrme Try Dvetil Verticle Vent Munt (LTV/Trillgy) Rer Flding Add On Bster Accessry Bse Pltfrm O2 Cyl Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 5

6 The HCPCS CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f HCPCS CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # HCPCS Definitin Price Desired Set Up Specifictins (Nt Required) Child's Nme Age: Dignsis: Height: Weight: 1. Tp f Hed t Set: Tp f Shulder t Set*: Under Arm t Set: Trunk Depth: Actul Sitting Depth*: Ft Length: 12. Width f Hed: Shulder Width: Chest Width: Hip Width: Lef t Lwer Leg Length*: Right Lwer Leg Length*: * Criticl Dimensins Custmer Serv ice: Fx: Specif ictins re subject t chnge withut ntice. Cpy right 2013 Sunrise Medicl REV. A Pge 6