Freedom Install Program Model: Purchase Order #: of frame for install Width: Freedom Install Program does not include power

Transcription

1 ustomer Information ate: Purchase Order #: ealer / cct. #: Ship to Street: Ship to ity: Ship to State: Ship to Zip ode: Office / Mobile #: Office Fax #: ddress: Quote to: Fax uyer: Marked For: Seating Specifications ack Height: Lateral Height: Lateral Width: Hip Width (rear): E Set Up Seat epth: F Hip Width (front): G E + 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. Finished imensions Standard cut is oltaron with foam rolled over edge. I G E F H Freedom esigns, Simply Seating Order Freedom esigns Upholstery Selections 1. hoose ontact / Non-ontact 2. hoose Upholstery 3. hoose omponent ody ontact Surface ravo Silver nti-microbial Upholstery Standard (fabric out) lack Only Reversed lack Only ushioned irmesh reathable Upholstery Standard (M-10) Incontinence Resistance acking (M-11) Other Upholstery Options Number: hoose: ody Non-ontact Surface ravo Standard Upholstery Standard (fabric out) lack Only Reversed lack Only ushioned irmesh reathable Upholstery Standard (M-10) Incontinence Resistance acking (M-11) Other Upholstery Options Number: hoose: Monogram Option Name: Script lock Thread olor: Embroidery Option esign: Wheelchair Specifications Freedom Install Program Model: Purchase Order #: of frame for install Width: Freedom Install Program does not include power epth: wheelchairs N. Madera Rd. Simi Valley, Phone Fax Page 1 of 17 Seat ase ack ase Headrest Pad Lateral Pads Hip & Knee Pads When ordering choose either Monogram or Embroidery Note: Freedom s NEW RVO SILVER fabric is another important step we have taken to help keep our kids healthy. n NTI-MIROIL fabric, RVO SILVER utilizes SILVER TEHNOLOGY to create a barrier to help control bacterial growth on contact. RVO SILVER is also latex free, highly incontinence resistant, fire retardant and F approved. Similar to artex, all RVO upholstery has a standard surface or can be reversed for easy cleaning. Freedom 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.

2 Freedom esigns, Inc. Seat (E2609) Simply Seating E1 Seat onstruction Includes: $ oltaron base material 3/8 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 Step 1. hoose E1-Kit (Seat) E1 Kit 2-Point djustable Mounting Hdwe & Seat to ack E1-Knob-Kit 2-Point djustable Mounting Hdwe & Seat to Hinge (rash Test pproved) ack Hinge (rash Test pproved) 2-585(X) luminum Fast lamp Hdwe ssy Knob Mounting Hdwe ssy Frame Stopper lamps 3/ Seat Mount racket luminum 30 egree rackets luminum 30 egree rackets Note: hoose 1 Seat to ack Hinge Option From Note: hoose 1 Seat to ack Hinge Option From E1-Knob-Kit Options: 1 E1 EXT Kit 2-Point Mounting Hdwe & Seat to ack Hinge 1 E1-Knob-4 Upgrade E1-Knob-Kit to 4-Point Knob Hdwe (replaces hinge) EZ Lite Extended Mounting Hdwe 2 E1-Knob- Upgrade E1-Knob-Kit to 2-Point Pin2 Pin-Lock Knob Hdwe Frame Stopper lamps 3/4-1 3 E1-Knob- Upgrade E1-Knob-Kit to 4-Point Pin4 Pin-Lock Knob Hdwe (replaces hinge) luminum 30 egree rackets Note: hoose 1 Seat to ack Hinge Option From Seat to ack Hinge Options Seat to ack Hinge Flush (pair) E1 4 Kit 4-Point djustable Mounting Hdwe NO Seat to ack Hinge (rash Test pproved) Seat to ack Hinge Offset (pair) 4-585(X) luminum Fast lamp Hdwe ssy Flip-nd-Fold Seat to ack Hinge (pair) Frame Stopper lamps 3/4-1 $331 $ 80 $416 Step 2. hoose ustomization to E1 Seat E1S1K nti-thrust Foam Modification $210 E1S1Y ontour Foam Modification -, & nti-thrust Height of nti-thrust shelf is 1" dductor height is 1" $326 = First 1/3 of set-up seat depth (see "E" page 1) Height of nti-thrust shelf is 1" = First 1/3 of set-up seat depth (see "E" page 1) E1S1V ontour Foam Modification -, nti- $283 E1S1Y ontour Foam Modification -, Thrust Only, NO nti-thrust E1S1V ontour Foam Modification - Only $283 E1S1W ontour Foam Modification -, nti-thrust Only E1S1W ontour Foam Modification - Only $326 $283 $ N. Madera Rd. Simi Valley, Phone Fax Page 2 of 17

3 Freedom esigns, Inc. Seat (E2609) Step 2. hoose ustomization to E1 Seat (continued) E1S1R symmetrical - Long Right $ 88 E1S1L symmetrical - Long Left $ 88 E1S1WW Flared Seat ut Modification for LEF $408 E1S1- Freedom Seat ROHO Insert $765 Frame (specify shape to fit LEF frame) ROHOSET (see page 16 to specify order) E1S1ML 1/2 Maple Laminate ase N/ E1S1 Modular ontour Foam Modification $432 E1S1WT ase with T-Nuts for Hardware N/ E1S1UU ut, arve, ontour Foam Mod. $461 (no tracks included) E1S1EE ase Only ut etween Rails $164 E1S1L Grid ut Foam Modification $333 E1S1G ushion Separate From ase $105 E1S1FF Removable Incontinence Slip over $204 E1S1I Incontinence Resistance Liner $ 30 Step 3. hoose Foam 1.5 Std 4# foam Only OR ustom Foam / Omit Standard Foam (see chart below) ase layer to be: Middle layer to be: Top layer to be: Seat Foam hart 3# Foam $ 45 per 1 Firm Sunmate $ 82 per 1 Pudgee $209 per 1 4# Foam $ 45 per 1 X-Soft T-Foam $ 89 per 1 Waffle $269 per.5 5# Foam $ 47 per 1 Soft T-Foam $ 89 per 1 Waffle (over 18x16) $540 per.5 Soft Sunmate $ 82 per 1 Medium T-Foam $ 89 per 1 Free Float $338 per.5 Medium Sunmate $ 82 per 1 Firm T-Foam $ 89 per 1 FreeFloat (over 18x16) $674 per N. Madera Rd. Simi Valley, Phone Fax Page 3 of 17

4 Freedom esigns, Inc. ack (E2617) Simply Seating E2 ack onstruction Includes: $ oltaron planar / flat base 3/8 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 Step 1. hoose E2-Kit (ack) E2 Kit 2-Point ttachment & Seat to ack Hinge E2 Knob Kit 2-Point ttachment & Seat to ack Hinge (rash Test pproved) (rash Test pproved) 2-585(X) Plastic Fast lamp Hdwe ssy Knob Mounting Hardware ssy Frame Stopper lamps 3/ ack Mount racket Note: hoose 1 Strap Riser (pair) from Note: hoose 1 Strap Riser (pair) from E2-Knob-Kit Options: 1 E2-Knob-4 Upgrade E2-Knob-Kit to 4-Point Knob Hdwe (replaces hinge) 2 E2-Knob-Pin2 Upgrade E2-Knob-Kit to 2-Point $ 84 Pin-Lock Knob Hdwe E2 4 Kit 4-Point ttachment - NO Seat to ack Hinge 3 E2-Knob-Pin4 Upgrade E2-Knob-Kit to 4-Point $476 (rash Test pproved) Pin-Lock Knob Hdwe (replaces hinge) 4-585(X) Plastic Fast lamp Hdwe ssy Frame Stopper lamps 3/4-1 Strap Riser hoices (choose 1 pair) INL. Note: hoose 1 Strap Riser (pair) 2 - MO-6 1-1/2 Wide Strap Opening, Flat from Link to Easy onforming ack Order Form - Std. (requires interrnet connection) $ MO Wide Strap Opening, Flat 2 - MO-6 1-1/2 Wide Strap Opening, 25 Rear end 2 - MO Wide Strap Opening, 25 Rear end Link to Easy onforming ack Order Form - Extended (requires interrnet connection) Step 2. hoose ustomization to E2 ack E22H I-ut Modification $128 E22I urved ase Modification $134 E E22J T-ut Modification $128 E22I urved Foam Modification $115 I-ut ase E E T-ut ase E F E F 2241 N. Madera Rd. Simi Valley, Phone Fax Page 4 of 17

5 Freedom esigns, Inc. ack (E2617) Step 2. hoose ustomization to E2 ack (continued) E22L E22L F iangular ut Modification / ual over iangular ut Modification / Single over E E G F H G H $303 E22 djustable Lumbar Modification (n/a with Toddler ack) $303 E J F E F J $299 E22ML 1/2 Maple Laminate ase N/ E22- ROHOK Freedom ack, ROHO Insert (see page 17 to specify) E22WT ase with T-Nuts for Hardware (no tracks included) N/ E22S Free Form Modification Soft/Med Sunmate - ox Kit (specify below) E22GG Ergo djustable Modification $422 E22SG Free Form Modification Soft/Med Sunmate - ag Kit (specify below) E22K Grid ut Foam Modification $333 E22S1 Liquid Soft/Med Sunmate Only - ox Kit (specify below) E22S1G Liquid Soft/Med Sunmate Only - ag Kit (specify below) Soft Sunmate Medium Sunmate $765 $259 $259 $242 $242 Step 3. hoose Foam 1 Std 4# foam Only OR ustom Foam / Omit Standard Foam (see chart below) ase layer to be: Middle layer to be: Top layer to be: ack Foam hart 3# Foam $ 45 per 1 Firm Sunmate $105 per 1 Pudgee $226 per 1 4# Foam $ 45 per 1 X-Soft T-Foam $113 per 1 Waffle $269 per.5 5# Foam $ 62 per 1 Soft T-Foam $113 per 1 Waffle (over 18x16) $540 per.5 Soft Sunmate $105 per 1 Medium T-Foam $113 per 1 Free Float $338 per.5 Medium Sunmate $105 per 1 Firm T-Foam $113 per 1 FreeFloat (over 18x16) $674 per N. Madera Rd. Simi Valley, Phone Fax Page 5 of 17

6 Freedom esigns, Inc. Medial Pelvic Support Package Each Part Number escription HPS Price Shape Standard Pad Sizing ustom Pad Size EE3-2 Lever Flip-own hoice of Pad (E0957 & 1028) EE3S Push utton, Flip-own hoice of Pad EE3P Hide way - Lever, Flip-own hoice of Pad (E0957 & 1028) (E0957 & 1028) $444 Wedge Small 3L x 3H x 3-2 Wedge $402 Oval Medium 4L x 3H x 3-2 Wedge $422 Round Large 5L x 4H x 4-2 Wedge X-Large 6L x 5H x 5-3 Wedge Medial Pelvic Support omponents Each Part Number escription HPS Price Part Number escription HPS Price MO-3M Protective oot For Hardware (K0108) $ 59 ea. MO-3E Medial Pelvic Support Pad Only (E0957) $170 ea. MO-3F Extended Flip racket for bductor (K0108) $ 28 ea Lever Flip-own Hdwe (EE3-2) W/ ST Top Plate 543 Hide way, Lever Flip-own Hdwe (EE3P) W/ ST Top Plate $248 ea. 581 Push utton Flip-own Hdwe (EE3S) W/ ST Top Plate (E1028 $248 ea. $232 ea. Lateral Pelvic Support Package Pair Mounted at Hips Part Number escription HPS Price Offset Standard Pad Sizing ustom Pad Size EE4 Fixed, Flush ST Hdwe & Pads (E0956) $237 1 Set Up Seat epth x 4H EE4 Fixed, Offset ST Hdwe & Pads (E0956) $237 2 Pad Profile (Specify Offset) EE4 Quick-Release, Flush or Offset ST (E0956 $474 Location Standard (1" thick) Hdwe & Pads (Flush & 1 Only) & 1028) Hip Thin (1/2" thick) Lateral Pelvic Support Package Pair Mounted at Knees Part Number escription HPS Price Offset Standard Pad Sizing ustom Pad Size EE4 Fixed, Flush ST Hdwe & Pads (E0956) $237 1 Set Up Seat epth x 4H EE4 Fixed, Offset ST Hdwe & Pads (E0956) $237 2 Pad Profile (Specify Offset) EE4 Quick-Release, Flush or Offset ST (E0956 $474 Location Standard (1" thick) Hdwe & Pads (Flush & 1 Only) & 1028) Knee Thin (1/2" thick) (Lateral Pelvic omponents continued next page) 2241 N. Madera Rd. Simi Valley, Phone Fax Page 6 of 17

7 Freedom esigns, Inc. Lateral Pelvic Support omponents - Pair Part Number escription HPS Price Part Number escription HPS Price MO-4 Lateral Pelvic Pads Only (E0956) $163 pr. MO-4 ontour Pad Modification (K0108) $ 90 pr. MO-4 Extended Lateral Pelvic Hardware (K0108) $ 84 pr. 450 Lateral racket, Fixed Flush ST (K0108) $ 56 pr. 442 Lateral racket, Fixed Offset ST (K0108) $ 60 pr. 443 Lateral racket, Fixed 2 Offset ST (K0108) $ 60 pr. 456 Lateral racket, Quick-Release Flush ST $282 pr. 456 Lateral racket, Quick-Release 1 Offset ST $282 pr.ee Lateral Thoracic Support Package Pair Part Number escription HPS Price Shape Pad Profile Std Pad Size ustom Pad Size EE5 Fixed, Flush ST Hdwe & Pads (E0956) $237 Flat Standard (1" thick) 4L x 3H EE5 Fixed, Offset ST Hdwe & Pads (E0956) $237 urved Thin (1/2" thick) 5L x 4H (Specify Offset) EE5E EE5W EE5P EE5K EE5Q Lift, Swing-way ST Hdwe & Pads (Specify Offset) Push-utton, Swing-way ST Hdwe & Pads (Specify Offset) Trigger, Swing-way ST Hdwe & Pads (Specify Offset) Lift, Swing-way Summer/Winter ST Hdwe & Pads (Specify Offset) Trigger, Swing-way Summer/ Winter ST Hdwe & Pads (Specify Offset) (E0956 & 1028) (E0956 & 1028) (E0956 & 1028) (E0956 & 1028) (E0956 & 1028) $474 Reverse urve $474 $532 $633 $669 6L x 5H Lateral Thoracic Support omponents Pair Part Number escription HPS Price Part Number escription HPS Price EE5I Tracks For Lateral Hdwe Mounting (K0108) $ 52 pr. MO-5G Lateral Thoracic Pads Only (E0956) $171 pr. MO-5F Protective oots for Hardware (K0108) $ 54 pr. MO-5J Extended Hardware (K0108) $ 84 pr. 450 Lateral racket, Fixed Flush ST (K0108) $ 56 pr. 442 Lateral racket, Fixed 1 Offset ST (K0108) $ 60 pr. 443 Lateral racket, Fixed 2 Offset ST (K0108) $ 60 pr. 455 Lateral racket, Lift Swing-way $294 pr. 455 Lateral racket, Lift Swing-way 1 $294 pr. Flush ST Offset ST 455 Lateral racket, Lift Swing-way 2 Offset ST $294 pr Lateral racket, Push-utton Swing- way Flush ST Lateral racket, Push-utton Swing- way 2 Offset ST Lateral racket, Trigger Swing-way Flush ST Lateral racket, Trigger Swing-way 2 Offset ST Lateral racket, Lift Swing-way, Summer/Winter Flush ST Lateral racket, Lift Swing-way, Summer/Winter 2 Offset ST Lateral racket, Trigger Swing-way, Summer/Winter Flush ST $294 pr. 587 Lateral racket, Push-utton Swing- way 1 Offset ST $294 pr. $336 pr. 510 Lateral racket, Trigger Swing-way 1 Offset ST $336 pr. $432 pr. 497 Lateral racket, Lift Swing-way, Summer/Winter 1 Offset ST Lateral racket, Trigger Swing-way, Summer/Winter 2 Offset ST $432 pr N. Madera Rd. Simi Valley, Phone Fax Page 7 of 17 $468 pr. 511 Lateral racket, Trigger Swing-way, Summer/Winter 1 Offset ST $468 pr. $294 pr. $336 pr. $432 pr. $468 pr.

8 Freedom esigns, Inc. Headrest Support Hardware Each Part Number escription HPS Price Part Number escription HPS Price Headrest Support Each Part Number escription HPS Price Standard Sizes 7756 hubbie Headrest Pad Only (E0955) $188 ea. X-Sm 8W x 3H Sm 10W x 4H Med 12W x 5H Lg 13.5W x 4.5H 7733 daptaplate - Headrest Hardware Interface Plate for Freedom esigns & Other Manufacturers 7700 Height, epth djustable - Removable Hdwe 7711 djust-eze Mulit-Position djustable Hdwe 7702 Flip-ack, Height & epth djustable (non-removable) 7708 Rock-N-Roll Height & epth djustable Hdwe (Removable) 7756-J hubbie 3-Piece djustable Headrest Pad (E0955 & $357 ea. Sm 10W x 4H Med 12W x 5H Lg 13.5W x 4.5H E1028) 7757 Low-Profile Headrest Pad (E0955) $149 ea. Sm 8.5W x 4H Med 9W x 4H Lg 13W x 4H 7753 Hinge-Loc 3-Piece djustable Headrest Pad E0955 & E1028) INLUE WITH LL E-2-KITS 7709 Rock-N-Roll Flip-ack, Height & epth djustable Hdwe (non-removable) $144 ea ST Multi-xis Headrest Hdwe - Offset 9.5 Horizontal ar $230 ea LONG Multi-xis Headrest Hdwe - Offset 11.5 Horizontal ar $282 ea. $393 ea. $314 ea. Sm 4W x 4H ll Pads Med 5W x 4H ll Pads Lg 5W x 5H ll Pads 7760 Skinny Headrest Pad Only (E0955) $188 ea. X-Sm 6W x 3.5H Sm 8W x 4.5H Med 10W x 4.5H Lg 12W x 4.5H $402 ea. $204 ea. $204 ea. Lower Extremity Supports Pair Part Number escription HPS Price Standard Sizes EE9 EE9- EE9F EE9F- 2-Point Hi-Tops STTI nkle Supports 2-Point Hi-Tops YNMI nkle Supports 3-Point Hi-Tops STTI nkle Supports 3-Point Hi-Tops YNMI nkle Supports (K0108) $111 pr. X-Small Small Medium Large losure Type (K0108) $111 pr. X-Small Small Medium Large Hook & Loop (K0108) $169 pr. X-Small Small Medium Large (K0108) $169 pr. X-Small Small Medium Large nkle ircumference Range: EE9H Foot & nkle Positioners (K0108) $210 pr. X-Small Small/Med Large EE9 Shoe Holders Hook & Loop (K0108) $166 pr. Small Small/Med Medium Med/Lg Large X-Large losure EE9 Shoe Holders uckle losure (K0108) $166 pr. Small Small/Med Medium Med/Lg Large X-Large EE9G Shoe Holders uckle losure nkle, Hook & Loop Toe Straps Shoe Holder Size (inches): Individual Leg radles (K0108) $603 pr One-Piece, ouble Leg Fooxbox (K0108) $515 ea. MO-8 1/4 lack S (umper) (K0108) $ 48 ea. uckle (K0108) $166 pr. Small Small/Med Medium Med/Lg Large X-Large 2.75W x 5L 3W x 5.75L 3.25W x 6.5L W W 3.5W x 7.25L 4.25W x 8.5L 4.5W x 10L Hanger Mount Footplate / Footboard Mount W or Width to Fit Frame H H W H 2241 N. Madera Rd. Simi Valley, Phone Fax Page 8 of 17

9 Freedom esigns, Inc. Freedom esigns nterior Support Tray Packages Wheelchair Tray Packages Including Hardware Part Number escription HPS Price /4 Lexan Tray - Hook & Loop Straps (E0950) $ /4 Lexan Tray - EZ Lite hannel Hardware (E0950) $ /4 Lexan Tray - EZ Lite hannel Hardware & Ribs (E0950) $ /2 irch Tray - Hook & Loop Straps (E0950) $ /8 Lexan Tray - Hook & Loop Straps (E0950) $ /8 Lexan Tray - djustable Knob Hardware & Ribs /2 irch Tray - djustable Knob Hardware & Ribs (E0950) $219 (E0950) $ /2 irch Tray - hannel racket Hardware (E0950) $ /2 irch Tray - Toggle Hardware (E0950) $ /8 Lexan Tray - hannel racket Hardware (E0950) $ /8 Lexan Tray - Toggle Hardware (E0950) $271 Standard Tray Sizes (pproximate) Size hair Tray ody ut X-Small x x 7 Small x x 7 Medium x x 9 Large x x 10 X-Large x x 10 dj Knob Release ST hannel racket Hook & Loop Straps Toggle Hardware EZ Lite hannel racket 2241 N. Madera Rd. Simi Valley, Phone Fax Page 9 of 17

10 Freedom esigns, Inc. Freedom esigns nterior Support Tray uild To Order Wheelchair Tray Hardware Part Number escription HPS Price 454 djustable Knob Release Hardware $102 pr. 454 djustable Toggle lamp Hardware $246 pr. 454 Hook & Loop Strap Hardware $ 80 pr. Standard Tray Sizes (pproximate) Size hair Tray ody ut X-Small x x 7 Small x x hannel racket Hardware $132 pr. 559 EZ Lite djustable hannel racket $132 pr. Medium x x 9 Large x x 10 X-Large x x 10 Wheelchair Trays - No Hardware Part Number escription HPS Price /4 Lexan Tray - No Hardware, No Ribs (E0950) $ /4 olteron Tray (E0950) $134 - No Hardware, No Ribs (lack) /8 Lexan Tray - No Hardware, No Ribs (E0950) $ /8 olteron Tray (E0950) $191 - No Hardware, No Ribs (lack) /2 irch Tray - No Hardware, No Ribs (E0950) $ N. Madera Rd. Simi Valley, Phone Fax Page 10 of 17

11 Freedom esigns, Inc. Freedom esigns nterior Support Tray Modifications & ccessories ustom Wheelchair Tray Modifications Part Number escription HPS Price Quantity MO-8 3/8 Lexan Material Upgrade For Trays (K0108) $ 64 Each MO-81 1/4 olteron Material Upgrade For Trays (K0108) $ 49 Each MO-82 3/8 olteron Material Upgrage For Trays (K0108) $ 96 Each MO-8 Joystick ut Out Right Left L x W (K0108) $ 87 Each MO-8G luminum Rim - 1/16 x 1 H Rims Sides and Front Edge (K0108) $ 54 Kit MO-8 hannel Tray Stopper Hardware Kit (K0108) $ 41 Kit MO-8H Plastic Rim Guard - 3/8 ttaches irectly To Tray Edge (K0108) $ 35 Each MO-8L Pad Tray - Tray Top Only Upholstery (K0108) $301 Each MO-8L-1 Pad Tray - Top & ottom Upholstery (K0108) $501 Each MO-8M Pad Tray - Half Tray Pad Upholstery (K0108) $253 Each MO-8N Ribs - Wood Lexan luminum (K0108) $ 48 Set MO-8P Overlay - 1/8 Lexan (K0108) $115 Each MO-8Q Underlay - 1/8 Lexan (K0108) $115 Each MO-8R Easel - Removable, djustable, 3/8 Lexan w/ Pencil Ledge (K0108) $222 Each MO-8S Tray Trim - 1/16 For luminum Rim (K0108) $ 35 Each MO-8T Slip over For Tray Padding Upholstery (K0108) $224 Each ustom Wheelchair Tray ccessories Part Number escription HPS Price Quantity MO-8J Rear Stability elt 1 Webbing W/ Side Release uckle (K0108) $ 39 Each MO-8K Elbow locks w/ L racket L x H (K0108) $237 Pair MO-8O Elbow Pads - Hook & Loop Mounting L x H (K0108) $110 Pair MO-8OW Elbow Pads - Wood ase L x H (K0108) $237 Pair Upholstery MO-8V Wrist Straps - Hook & Loop (K0108) $ 54 Pair Notes / iagrams: 2241 N. Madera Rd. Simi Valley, Phone Fax Page 11 of 17

12 Freedom esigns, Inc. Freedom Select nterior Trunk Supports Select Standard Select Narrow imensions Part Number escription E F G Price SFI-6SNZ-S Select Standard Small $ 133 SFI-6SNZ-1-S Select Standard ual Rear-Pull Small $ 133 SFI-6SNZ-M Select Standard Medium $ 133 SFI-6SNZ-1-M Select Standard ual Rear-Pull Medium $ 133 SFI-6SNZ-L Select Standard Large $ 143 SFI-6SNZ-1-L Select Standard ual Rear-Pull Large $ 143 SFI-6SNZ-XL Select Standard Extra Large $ 143 SFI-6SNZ-1-XL Select Standard ual Rear-Pull Extra Large $ 143 SFI-6USTOM Select nterior Support ustom Sizing (specify) $ 194 Note: SFI-6NNZ-XS Select Narrow X-Small $ 133 SFI-6NNZ-1-XS Select Narrow ual Rear-Pull X-Small $ 133 SFI-6NNZ-S Select Narrow Small $ 133 SFI-6NNZ-1-S Select Narrow ual Rear-Pull Small $ 133 SFI-6NNZ-M Select Narrow Medium $ 133 SFI-6NNZ-1-M Select Narrow ual Rear-Pull Medium $ 133 SFI-6NNZ-L Select Narrow Large $ 138 SFI-6NNZ-1-L Select Narrow ual Rear-Pull Large $ 138 SFI-6NNZ-XL Select Narrow Extra Large $ 143 SFI-6NNZ-1-XL Select Narrow ual Rear-Pull Extra Large $ 143 SFI-6USTOM Select nterior Support ustom Sizing (specify) $ N. Madera Rd. Simi Valley, Phone Fax Page 12 of 17

13 Freedom esigns, Inc. Freedom Select nterior Trunk Supports (continued) Select Standard Zipper Select Narrow Zipper imensions Part Number escription E F G Price SFI-6SZ-S Select Standard Zipper Small $ 138 SFI-6SZ-1-S Select Standard Zipper ual Rear-Pull Small $ 138 SFI-6SZ-M Select Standard Zipper Medium $ 138 SFI-6SZ-1-M Select Standard Zipper ual Rear-Pull Medium $ 138 SFI-6SZ-L Select Standard Zipper Large $ 143 SFI-6SZ-1-L Select Standard Zipper ual Rear-Pull Large $ 143 SFI-6SZ-XL Select Standard Zipper Extra Large $ 148 SFI-6SZ-1-XL Select Standard Zipper ual Rear-Pull Extra Large $ 148 SFI-6USTOM Select nterior Support ustom Sizing (specify) $194 SFI-6NZ-M Select Narrow Zipper Medium $ 138 SFI-6NZ-1-M Select Narrow Zipper ual Rear-Pull Medium $ 138 SFI-6NZ-L Select Narrow Zipper Large $ 143 SFI-6NZ-1-L Select Narrow Zipper ual Rear-Pull Large $ 143 SFI-6NZ-XL Select Narrow Zipper Extra Large $ 148 SFI-6NZ-1-XL Select Narrow Zipper ual Rear-Pull Extra Large $ 148 SFI-6USTOM Select nterior Support ustom Sizing (specify) $194 Note: 2241 N. Madera Rd. Simi Valley, Phone Fax Page 13 of 17

14 Freedom esigns, Inc. Freedom Select nterior Pelvic Supports Select 2-Point 2-POINT PE EZ RELESE PUSH UTTON UKLE Part Number SIZE UKLE PRIE SFI-32MP-XS XS MIRO 1" $ 77 SFI-32MP-S S MIRO 1" $ 77 SFI-32P-S S ST 1.5" $ 77 SFI-32P-M M ST 1.5" $ 77 SFI-32P-L L ST 1.5" $ 77 SFI-32LP-L L LG 2" $ 77 SFI-32LP-XL XL LG 2" $ 77 SFI-32P-USTOM QUOTE IMENSIONS TO ORER $ 97 2-POINT PE SIE RELESE UTTON UKLE Part Number SIZE UKLE PRIE SFI-32MS-XS XS MIRO $ 56 SFI-32MS-S S MIRO 1" $ 56 SFI-32S-S S ST 1.5" $ 56 SFI-32S-M M ST 1.5" $ 56 SFI-32S-L L ST 1.5" $ 56 USTOM ELT IMENSIONS SFI-32LS-L L LG 2" $ 56 SFI-32LS-XL XL LG 2" $ 56 SFI-32S-USTOM QUOTE IMENSIONS TO ORER $ 77 Note: 2-POINT UNPE EZ RELESE PUSH UTTON UKLE SIZE UKLE PRIE SFI-32UMP-XS XS MIRO 1" $ 37 SFI-32UMP-S S MIRO 1" $ 37 SFI-32UP-S S ST 1.5" $ 37 SFI-32UP-M M ST 1.5" $ 37 SFI-32UP-L L ST 1.5" $ 37 SFI-32ULP-L L LG 2" $ 37 SFI-32ULP-XL XL LG 2" $ 37 FREEOM SELET 2-POINT NTERIOR PELVI SUPPORT PS PRIE E. PRIE PR. SFI-3HP-XS $ 26 $ 52 SFI-3HP-S $ 26 $ 52 SFI-3HP-M $ 26 $ 52 SFI-3HP-L $ 26 $ 52 SFI-3HP-XL $ 26 $ 52 SFI-3HP-USTOM $ 36 $ 72 Note: SFI-32UP-USTOM QUOTE IMENSIONS TO ORER $ N. Madera Rd. Simi Valley, Phone Fax Page 14 of 17

15 Freedom esigns, Inc. Freedom Select nterior Pelvic Supports (continued) 2-POINT UNPE SIE RELESE UTTON UKLE PRT NUMER SIZE UKLE PRIE SFI-32UMS-XS XS MIRO 1" $ 32 SFI-32UMS-S S MIRO 1" $ 32 SFI-32US-S S ST 1.5" $ 32 SFI-32US-M M ST 1.5" $ 32 SFI-32US-L L ST 1.5" $ 32 SFI-32ULS-L L LG 2" $ 32 SFI-32ULS-XL XL LG 2" $ 32 SFI-32US-USTOM QUOTE IMENSIONS TO ORER $ 42 FREEOM SELET 2-POINT NTERIOR PELVI SUPPORT PS PRIE E. PRIE PR. SFI-3HP-XS $ 26 $ 52 SFI-3HP-S $ 26 $ 52 SFI-3HP-M $ 26 $ 52 SFI-3HP-L $ 26 $ 52 SFI-3HP-XL $ 26 $ 52 SFI-3HP-USTOM $ 36 $ 72 F E Select 4-Point 4-POINT EZ RELESE PUSH UTTON UKLE PRT NUMER SIZE UKLE E F PRIE SFI-34MP-XS XS MIRO 1" $168 SFI-34MP-S S MIRO 1" $168 SFI-34P-S S ST 1.5" $168 SFI-34P-M M ST 1.5" $168 SFI-34P-L L ST 1.5" $168 SFI-34LP-XL XL LG 2" $168 SFI-34P-USTOM QUOTE IMENSIONS TO ORER $194 4-POINT IRLINE STYLE LIFT RELESE UKLE PRT NUMER SIZE UKLE E F PRIE SFI-34-S S ST 1.5" $168 SFI-34-M M ST 1.5" $168 SFI-34-L L ST 1.5" $168 SFI-34-XL XL LG 2" $168 SFI-34-USTOM QUOTE IMENSIONS TO ORER $194 4-POINT SIE RELESE UTTON UKLE PRT NUMER SIZE UKLE E F PRIE SFI-34MS-XS XS MIRO 1" $168 USTOM ELT IMENSIONS E F SFI-34MS-S S MIRO 1" $168 SFI-34S-S S ST 1.5" $168 SFI-34S-M M ST 1.5" $168 SFI-34S-L L ST 1.5" $168 SFI-34LS-XL XL LG 2" $168 SFI-34S-USTOM QUOTE IMENSIONS TO ORER $ N. Madera Rd. Simi Valley, Phone Fax Page 15 of 17

16 Freedom esigns, Inc. PO# Marked for: ell Size eleted ells ase Intact X MO-1ROHO SET Freedom Seat ROHO Insert $ Note: Retail pricing includes any combination of specification option. FRONT OF INSERT OLUMNS INHES ELLS E F G H I J K L ut Out ells & ase Valve Hose Location orner & ell Height V1 V2 V3 V4 Select Seat hoice Standard R O W S INHES RE FROM SE EGE TO EGE OF INSERT symmetrical Left symmetrical Right 1. Start diagram at cell 1 which represents front left of cushion from client s seated position. 2. Specify ell Height (1, 2. 3 or 4 ) by placing a number in each cell box. 3. Specify request to elete ells with ase Intact by typing an X in those cell boxes. 4. Specify request to ut Out ells & ase by typing a in those cell boxes. 5. Specify Valve Hose Location orner & ell Height by typing V1, V2, V3 or V4 in that corner box. Note: For multiple valve or custom valve locations and custom air chamber divisions call Freedom esigns ustomer Service for assistance at Other PLESE LLOW 3-4 WEEKS FOR ELIVERY 2241 N. Madera Rd. Simi Valley, Phone Fax SOSS Rev Page 16 of 17

17 Freedom esigns, Inc. PO# Marked for: ell Size eleted ells ase Intact X MO-2ROHO K Freedom ack ROHO Insert $ Note: Retail pricing includes any combination of specification option. INHES ELLS TOP OF INSERT OLUMNS E F G H I J K L ut Out ells & ase Valve Hose Location orner & ell Height V1 V2 V R O W S Select ack hoice Standard I ack T ack INHES RE FROM SE EGE TO EGE OF INSERT 1. Start diagram at cell 1 which represents top right of back from client s seated position. 2. Specify ell Height (1, 2. or 3 ) by placing a number in each cell box. 3. Specify request to eleted ells with ase Intact by typing an X in those cell boxes. 4. Specify request to ut Out ells & ase by typing a in those cell boxes. 5. Specify Valve Hose Location orner & ell Height by typing V1, V2, or V3 in that corner box. Note: For multiple valve or custom valve locations and custom air chamber divisions call Freedom esigns ustomer Service for assistance at PLESE LLOW 3-4 WEEKS FOR ELIVERY 2241 N. Madera Rd. Simi Valley, Phone Fax SOSS Rev Page 17 of 17