Street Corpus

(1)

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

Street Corpus

(2)

Base

Select Options:

Part Number Description Retail Price:

Street Corpus Base

I102007-99-0 $8,995.00

Price Includes: RWD Power Base, Four-Wheel Adjustable Independent Suspension System, High Speed Four Pole Motors and Custom Gear Boxes designed for maximum reliability and performance, Pilot Plus Controller, 100 Amp Electronics, Remote Swing Away Advanced Joystick, Tie-down Hardware for strap systems, Easy Front & Rear Access to the Battery Compartments, Charger and Freight. Weight Limit 310lbs.

Select one of the following:

Street Base Cover Gold/Black

I102012-99-0 No Charge

Street Base Cover Silver/Black

Street Base Cover Blue Metallic

Street Base Cover Brown Metallic

Base Options

Select Options:

Batteries, Group 24 Sealed LA/Gel, Installed

IM24 SLD G FT $675.00

Power Adjustable Seat Height, 10" Travel

I102048-99-0 $2,230.00

Fixed Seat Height

Fixed Seat Height, +2"

I102047-99-0 $210.00

9" Casters-Solid Tires

Front Fork For Casters Small

P+ PP1A Programmer

I602307-99-0 $457.00

Joystick Options

Cone shaped joystick knob is standard.

Chin Cup For Joystick Knob

I100960-99-0 $73.00

"T" Handle For Joystick Knob

I100961-99-0 $107.00

"Large Ball" For Joystick Knob

I100962-99-0 $73.00

"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 $97.00

Select Options:

Joystick Mount-Right

Joystick Mount-Left

Retractable joystick Mnt Right

I100819-99-0 $426.00

Retractable joystick Mnt Left

I100824-99-0 $426.00

Midline Control Mount

I101260-99-0 $231.00

Pilot+ series Joystick w/ 7 Buttons

ID49670/3 No Charge

Pilot+Series joystick T/S

ID50002 $165.00

Toggle switches for power and mode.

Pilot+ Joystick M/J

ID49880 $165.00

(3)

Joystick Options

Select Options:

P+DAC Attendant Control

ID49682 $995.00

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

Seating System

Price Includes:

I10119

Corpus Seat Frame, Ergo Back Cushion (Standard Size) with Adjustable Recline Angle, Height Adjustable Armrest Assembly, Solid Seat Pan (17"w x 18"d), Legrest Assembly with Adjustable Elevation and Positioning Belt. Seat Control Kit and Seat Functions Through Joystick included with Power Tilt and Recline Systems. Weight Limit 250lbs.

Corpus Seat w/ 45° Power Tilt

I10120 $5,895.00

Corpus Seat w/ Power Recline

I10121 $6,695.00

Corpus Seat w/ 45° Power Tilt & Power Recline

I10122 $10,998.00

Corpus Seat HD w/o Power Tilt or Recline

I10125 $4,695.00

Weight Limit 310 lbs.

Seating System Options

Select Options:

Seat Function Control Kit With Membrane Switch Box

Toggle Switch Kit For Membrane Switch Box

I100524-99-0 $101.00

Seat Control Joyswitch

IJOYSWITCH $816.00

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.

Alternating Seat Control

IALTSWITCH $816.00

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

Ergo Back Fixed 14" Wide Leatherette 25.5" High

I100734-99-0 $828.00

Ergo Back Fixed 14" Wide Fabric 25.5" High

I100731-99-0 $854.00

Ergo Back Fixed 14" W x 21" H Leatherette

I311106-00-90-0 $828.00

Ergo Back Fixed 14" W x 21" H Fabric

I311106-00-80-0 $854.00

Ergo Back Recline 16"W Leatherette 25.5" High

Ergo Back Recline 16"W Fabric 25.5" High

I100743-99-0 $583.00

Ergo Back Recline 16" W x 21" H Leatherette

I311108-00-90-0 $557.00

Ergo Back Recline 16" W x 21" H Fabric

I311108-00-80-0 $583.00

Ergo Back Recline 18"W Leatherette 25.5" High

Ergo Back Recline 18"W Fabric 25.5" High

I100744-99-0 $785.00

Ergo Back Recline 18" W x 21" H Leatherette

I311110-00-90-0 $759.00

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Backrest Options

Ergo Back Recline 18" W x 21" H Fabric

I311110-00-80-0 $785.00

Rectangular Backrest 16 W

I10004 $982.00

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

Rectangular Backrest 18 W

I10005 $1,147.00

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

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

I305510-00-90-0 $706.00

Ergo Back Fixed Tall 16"W x 29.5"H Fabr

I305510-00-80-0 $731.00

Select Options:

Custom Ergo Back Height ____"

I10014 $546.00

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

Split Backrest

I100972-99-0 $312.00

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

Seat Sizing

Corpus Seat 17"W x 14"D No Cushion

I102024-99-0 $595.00

I102027-99-0 $595.00

I102038-99-0 $595.00

I102044-99-0 $595.00

I102033-99-0 $595.00

I102039-99-0 $1,190.00

I102045-99-0 $1,190.00

Special Seat Size 21"W x 18"D No Cushion

I10007 $1,190.00

I10008 $1,190.00

I10009 $1,190.00

I10010 $1,190.00

I10011 $1,190.00

I10012 $1,190.00

Select Options:

Ergonomic Seat Cushion Leatherette

I10038 $304.00

Ergonomic Seat Cushion Fabric

I10039 $330.00

Armrest Options

Armrest 4"x10" Right Leatherette

I100550-99-0 $73.00

Armrest 4"x10" Right Fabric

I100542-99-0 $83.00

I100543-99-0 $10.00

I100552-99-0 $73.00

I100544-99-0 $83.00

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Armrest Options

I100553-99-0 $73.00

I100545-99-0 $83.00

Armrest 4"x10" Left Leatherette

I100546-99-0 $73.00

Armrest 4"x10" Left Fabric

I100538-99-0 $83.00

I100539-99-0 $10.00

I100548-99-0 $73.00

I100540-99-0 $83.00

I100549-99-0 $73.00

I100541-99-0 $83.00

Select Options:

Height Adjustable Armrest Assembly

I10126 No Charge

18" Between Armrests w/ 16" Backrest

I304968-99-0 $180.00

20" Between Armrest w/ 18" Backrest

I10001 $239.00

Armrest Mount High

Armrest Mount Low (High Position Standard)

Armrest Height Ext (+2")

I100523-99-0 $84.00

Arm Trough Adaptor 1" Pair

IARMADAP1" $219.00

For aftermarket arm troughs.

Arm Trough Adaptor 7/8" Pair

IARMADAP7/8" $219.00

For aftermarket arm troughs.

Armrest Pouch-Right

I100671-99-0 $141.00

Armrest Pouch-Left

I100672-99-0 $141.00

Armrest Side Support Right Inner

I101263-99-0 $112.00

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

Armrest Side Support Right Outer

I101261-99-0 $112.00

Armrest Side Support Left Inner

I101264-99-0 $112.00

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

Armrest Side Support Left Outer

I101262-99-0 $112.00

Armrest Supports HD

I308506-99-0 $395.00

Legrest Options

Select Options:

Power Articulating Elevating Legrest

I102054-99-0 $1,998.00

Manual Adjustment Legrest Elevation

Calf Supports Leatherette

Calf Supports Fabric

I100516-99-0 $10.00

Legrest Assm. 2pc Narrow Footplates (Complete)

Legrest Assm. 2pc Wide Footplates (Complete)

Leg Length Ext Kit (pair) 16-21" From Seat Pan

I10024 $195.00

Standard length is 11-17" from seat pan to footplate.

(6)

Accessories

Select Options:

Headrest-Removable Leatherette-For Ergo Back

I100509-99-0 $422.00

Headrest-Removable Fabric-For Ergo Back

I100508-99-0 $448.00

Universal Headrest Adapter

IHEADADAPTER $156.00

Lateral Supports Std. Leatherette-ErgoBack Only

I305266-28-90-0 $401.00

Lateral Supports Std. Fabric-Ergo Back Only

I305266-28-80-0 $426.00

Swing Away Trunk Supports Leatherette-For Ergo Back

I100521-99-0 $615.00

Swing Away Trunk Supports Fabric-For Ergo Back

I100520-99-0 $641.00

Lateral Wedges, Pair

Long Thigh Supports Leatherette

I100513-99-0 $453.00

Long Thigh Supports Fabric

I100512-99-0 $479.00

Short Thigh Supports Leatherette

I100511-99-0 $453.00

Short Thigh Supports Fabric

I100510-99-0 $479.00

Abductor Kit

I100978-99-0 $435.00

Knee Block Assembly Corpus

I10015 $552.00

Transfer Handles

I100974-99-0 $369.00

Push Handles

I100975-99-0 $297.00

Back Pack Clips Carabiner Style

I101473-99-0 $49.00

Back Pack Hooks

I100981-99-0 $32.00

Medical Necessities Bag

I102059-99-0 $195.00

Positioning Belt

Positioning Belt Retractable

I100519-99-0 $166.00

Positioning Belt Retractable Long

I100600-99-0 $186.00

Upper Extremity Support Small, Angle Adjustable

I100578-99-0 $376.00

Swing Away Mounting

Upper Extremity Support Angle Adjustable. 14" W

I100575-99-0 $426.00

I100576-99-0 $436.00

I100577-99-0 $459.00

Upper Extremity Support Joystick Cutout 16" W

I100571-99-0 $474.00

Upper Extremity Support Joystick Cutout 18" W

I100572-99-0 $474.00

Upper Extremity Support Mid Joystick Cutout 16"W

I100573-99-0 $549.00

Upper Extremity Support Mid Joystick Cutout 18"W

I100574-99-0 $549.00