Chairman 2k Stander JR

(1)

Chairman 2k Stander JR

PO#:

Dealer Name:

Address:

Phone#:

Contact:

Dealer Code:

City:

Fax#:

First Name:

Last Name:

Weight:

Height:

A) Top of Shoulders:

B) Chest Depth:

C) Chest Width:

D) Seat Depth:

E) Top of Head:

F) Elbow to Hand:

G) Seat Pan to Elbow:

H) Hip Width:

I) Knee to Foot:

Please send order/quote to fax#: (800) 231-3256 Effective October 9th 2003 All specifications and prices are subject to change without notice.

Permobil Inc.

6961 Eastgate Blvd.

Lebanon, TN 37090 Tel: (800) 736-0925 Fax: (800) 231-3256 www.permobil.com State/Zip:

Diagnosis:

Permobil recommends that the client is evaluated by a certified rehab specialist.

Required information for chair to be properly adjusted to client's measurements.

Dealer Information

Client Information

Client Measurements

(2)

Base

Select Options:

Part Number Description Retail Price:

$9,995.00 Chairman C2K Stand JR

I101109-99-0

Price Includes: FWD Power Base Configured for Standing Seat, Shock Absorbing Suspension System, Programmable Pilot Plus Controller, Remote Joystick with Swing Away Hardware, Tie-down Hardware for Strap Systems, Charger and Freight. Weight Limit 155lbs.

Select one of the following:

No Charge C2K Base Cover Silver/Black

I100536-99-0

No Charge C2K Base Cover Gold/ Black

I100537-99-0

No Charge C2K Base Cover Deep Blue

I100535-99-0

No Charge C2K Base Cover Red

I100534-99-0

No Charge C2K Base Cover Silver

I100533-99-0

Base Options

Select Options:

$675.00 Batteries, Group 24 Sealed LA/Gel, Installed

IM24 SLD G FT

$2,130.00 Power Adjustable Seat Height, 8" Travel

I100558-99-0

To assist in transfers.

No Charge Seat Tube Fixed

I100499-99-0

$321.00 Anti-Tippers

I100522-99-0

No Charge Seat Stabilizer-C2K

I100570-99-0

$887.00 C2K Light Kit

I100993-99-0

$457.00 P+ PP1A Programmer

I602307-99-0

Joystick Options

Cone shaped joystick knob is standard.

$73.00 Chin Cup For Joystick Knob

I100960-99-0

$107.00

"T" Handle For Joystick Knob I100961-99-0

$73.00

"Large Ball" For Joystick Knob I100962-99-0

$97.00

"Softball" For Joystick Knob I100963-99-0

$97.00

"Mushroom" For Joystick Knob I100964-99-0

$97.00

"Stick" For Joystick Knob I100965-99-0

Select Options:

No Charge Joystick Mount-Right

I100398-99-0

No Charge Joystick Mount-Left

I100399-99-0

$426.00 Retractable joystick Mnt Right

I100819-99-0

$426.00 Retractable joystick Mnt Left

I100824-99-0

$231.00 Midline Control Mount

I101260-99-0

No Charge Pilot+ series Joystick w/ 7 Buttons

ID49670/3

$165.00 Pilot+Series joystick T/S

ID50002

Toggle switches for power and mode.

$165.00 Pilot+ Joystick M/J

ID49880

1/8" Mini-mono jack switch ports for power and mode. (Switches not included)

(3)

Joystick Options

Select Options:

$995.00 P+ Attendant Control

ID49682

For additional joystick options see the Alternative Drive Systems order form.

Seating System

Price Includes:

Standing Seat Frame with Adjustable Seat Depth, Power Standing Feature, Fixed Chest Bar, Solid Seat Pan, Knee Block Assembly, Seat Control Panel with Toggle Switches, and Positioning Belt. Weight Limit 155lbs.

$9,995.00 Standing Seat System

I101431-99-0

$12,795.00 Standing Seat w/ 160° Power Recline

I101505-99-0

$12,795.00 Standing Seat w/ 30° Power Tilt

I101432-99-0

$13,395.00 Combination Standing Seat Junior

I101438-99-0

Includes 16 degrees power tilt and 175 degree power recline

Seating System Options

Select Options:

No Charge Seat Function Control Kit Toggle Switch Box

I101430-99-0

$816.00 Seat Control Joyswitch

IJOYSWITCH

Multi directional toggle to operate up to 4 power seat functions. Provides an alternative to the membrane switch box and accessing seat functions through the drive control.

$816.00 Alternating Seat Control

IALTSWITCH

Seat function interface box which accommodates 4 single momentary switches. 1/8" mini-mono switches not included. Provides an alternative to the membrane switch box and accessing seat functions through the drive control.

Backrest Options

Backrest height measured from seat pan

$828.00 Ergo Backrest 14" Wide Leatherette 25.5" High

I100794-99-0

$854.00 Ergo Backrest 14" Wide Fabric 25.5" High

I100791-99-0

I100795-99-0

I100792-99-0

I100796-99-0

I100793-99-0

No Charge Omit Backrest Kit 14" W Between Armrests

I100434-99-0

I100435-99-0

I100436-99-0

$982.00 Rectangular Backrest 16 W Plastic Shell

I10004

Choose backrest height from seat pan: 17"-29" ___"

$1,147.00 Rectangular Backrest 18 W Metal Shell

I10005

Choose backrest height from seat pan: 17"-29" ___"

$706.00 Ergo Back Fixed Tall 16"W x 29.5"H Leatherette

I305510-00-90-0

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Backrest Options

$731.00 Ergo Back Fixed Tall 16"W x 29.5"H Fabric

I305510-00-80-0 Select Options:

No Charge 21" Back Height (Ergo Only)

I10047

$546.00 Custom Ergo Back Height ____"

I10014

Backrest height measured from seat pan. Price in addition to above backrest.

$312.00 Split Backrest

I100972-99-0

Split Backrest and cushion 8" from top to allow for transfers and/or transportation. N/A on short back heights. Split cushion? Y or N

$209.00 Backrest Reinforcement

I101101-99-0

Seat Sizing

No Charge Standing Seat 17"W x 14"D NO Cushion

I101036-99-0

I101039-99-0

I100415-99-0

I100418-99-0

I100421-99-0 Select Options:

$304.00 Ergonomic Seat Cushion Leatherette

I10038

$330.00 Ergonomic Seat Cushion Fabric

I10039

Armrest Options

$73.00 Armrest 4"x10" Right Leatherette

I100550-99-0

$83.00 Armrest 4"x10" Right Fabric

I100542-99-0

No Charge Armrest 4"x12" Right Leatherette

I100551-99-0

I100543-99-0

I100552-99-0

I100544-99-0

I100553-99-0

I100545-99-0

$73.00 Armrest 4"x10" Left Leatherette

I100546-99-0

$83.00 Armrest 4"x10" Left Fabric

I100538-99-0

No Charge Armrest 4"x12" Left Leatherette

I100547-99-0

I100539-99-0

I100548-99-0

I100540-99-0

I100549-99-0

I100541-99-0

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Armrest Options

Select Options:

$249.00 Height Adjustable Armrest Assembly

I10016

This item must be checked if ordering armrests.

$180.00 18" Between Armrests w/ 16" Backrest

I304968-99-0

No Charge Armrest Mount High

I101003-99-0

No Charge Armrest Mount Low (High Position Standard)

I101002-99-0

$84.00 Armrest Height Ext (+2")

I100523-99-0

$219.00 Arm Trough Adaptor 1" Pair

IARMADAP1"

For aftermarket arm troughs.

$219.00 Arm Trough Adaptor 7/8" Pair

IARMADAP7/8"

For aftermarket arm troughs.

$141.00 Armrest Pouch-Right

I100671-99-0

$141.00 Armrest Pouch-Left

I100672-99-0

$112.00 Armrest Side Support Right Inner

I101263-99-0

Recommend 2" wider width between the armrest to ensure armrests will flip-up.

$112.00 Armrest Side Support Right Outer

I101261-99-0

$112.00 Armrest Side Support Left Inner

I101264-99-0

Recommend 2" wider width between the armrest to ensure armrests will flip-up.

$112.00 Armrest Side Support Left Outer

I101262-99-0

Legrest Options

No Charge Legrest, Junior-Leatheret (For Stand Only orTilt)

I100815-99-0

$10.00 Legrest, Junior-Fabric (For Stand Only orTilt)

I100814-99-0

No Charge Legrest, Adult-Leatherett (For Stand Only orTilt)

I100817-99-0

$10.00 Legrest, Adult-Fabric (For Stand Only orTilt)

I100816-99-0

No Charge Legrest, Junior-Leath. (For Combi or Recline)

I100821-99-0

$10.00 Legrest, Junior-Fabric (For Combi or Recline)

I100820-99-0

No Charge Legrest, Adult-Leath. (For Combi or Recline)

I100823-99-0

$10.00 Legrest, Adult-Fabric (For Combi or Recline)

I100822-99-0

$1,902.00 Stand and Drive Legrest Assembly JR-Leatherette

I101259-99-0

This assembly includes electronics which allow the chair to drive while standing and is available on the Combination seat only. Wheels under footplate act as anti-tippers.

$1,928.00 Stand and Drive Legrest Assembly JR-Fabric

I101258-99-0

This assembly includes electronics which allow the chair to drive while standing and is available on the Combination seat only. Wheels under footplate act as anti-tippers.

Select Options:

No Charge Calf Supports Leatherette

I101045-99-0

$10.00 Calf Supports Fabric

I101044-99-0

Accessories

Select Options:

$422.00 Headrest-Removable Leatherette-For Ergo Back

I100509-99-0

$448.00 Headrest-Removable Fabric-For Ergo Back

I100508-99-0

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Accessories

Select Options:

$156.00 Universal Headrest Adapter

IHEADADAPTER

$401.00 Lateral Supports Std. Leatherette-ErgoBack Only

I305266-28-90-0

$426.00 Lateral Supports Std. Fabric-Ergo Back Only

I305266-28-80-0

$615.00 Swing Away Trunk Supports Leatherette-For Ergo Back

I100521-99-0

$641.00 Swing Away Trunk Supports Fabric-For Ergo Back

I100520-99-0

No Charge Lateral Wedges, Pair

I306400-00-0

$194.00 Chest Bar 14" Adjustable Leatherette

I101099-99-0

$219.00 Chest Bar 14" Adjustable Fabric

I101098-99-0

I101095-99-0

I101094-99-0

I101097-99-0

I101096-99-0

$453.00 Small Thigh Supports Leatherette

I101041-99-0

$479.00 Small Thigh Supports Fabric

I101040-99-0

$435.00 Abductor Kit

I100978-99-0

$369.00 Transfer Handles

I100974-99-0

$297.00 Push Handles

I101100-99-0

$49.00 Back Pack Clips Carabiner Style

I101473-99-0

$32.00 Back Pack Hooks

I100981-99-0

$247.00 C2K Essentials Carrier

I101500-99-0

No Charge Positioning Belt

I100518-99-0

$376.00 Upper Extremity Support Small, Angle Adjustable

I100578-99-0

Swing Away Mounting

$426.00 Upper Extremity Support Angle Adjustable. 14" W

I100575-99-0

I100576-99-0

I100577-99-0

$474.00 Upper Extremity Support Joystick Cutout 16" W

I100571-99-0

$474.00 Upper Extremity Support Joystick Cutout 18" W

I100572-99-0

$549.00 Upper Extremity Support Mid Joystick Cutout 16"W

I100573-99-0

$549.00 Upper Extremity Support Mid Joystick Cutout 18"W

I100574-99-0