Chairman 2k Lowrider

(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

Chairman 2k Lowrider

(2)

Base

Select Options:

Part Number Description Retail Price:

$9,995.00 Chairman C2K Lowrider

I101265-99-0

Price Includes: FWD Power Base, Programmable Pilot Plus Controller, Shock Absorbing Suspension System, 16.5" Seat Pan to Floor Height, Remote Joystick with Swing Away Hardware, Tie-down Hardware for Strap Systems, Charger and Freight. Weight Limit 310lbs.

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 Lowrider 6" Travel

I311200-99-0

To assist in transfers.

No Charge Seat Tube, 6" Lowrider

I10117

$321.00 Anti-Tippers

I100522-99-0

$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+DAC Attendant Control

ID49682

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

Seating System

Price Includes:

Corpus Seat Frame, Back Frame with Adjustable Recline Angle, Center Mounted Recline Braket, Reclining Armrest Assembly, Solid Seat Pan (17"w x 18"d), Legrest Assembly, with Adjustable Elevation and Positioning Belt. Weight Limit 250lbs.

$5,695.00 Lowrider Seat w/20° Power Tilt

I10050

$10,988.00 Lowrider Seat w/20° Power Tilt & 120° Power Recline

I10051

This utilizes an actuator mounted behind the backrest with a reinforced mounting system.

Seating System Options

Select Options:

$1,809.00 Heavy Duty Package Lowrider

I10085

Heavy Duty Package Includes: Anti-tippers, heavy duty armrest supports, drive inhibit for Power Adjustable Seat Height and heavy duty mount for recline. For weight limits of 250-310lbs.

No Charge Seat Function Control Kit With Membrane Switch Box

I101280-99-0

$101.00 Toggle Switch Kit For Membrane Switch Box

I100524-99-0

$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 Back Fixed 14" Wide Leatherette 25.5" High

I100734-99-0

$854.00 Ergo Back Fixed 14" Wide Fabric 25.5" High

I100731-99-0

$828.00 Ergo Back Fixed 14" W x 21" H Leatherette

I311106-00-90-0

$854.00 Ergo Back Fixed 14" W x 21" H Fabric

I311106-00-80-0

$557.00 Ergo Back Recline 16"W Leatherette 25.5" High

I100746-99-0

$583.00 Ergo Back Recline 16"W Fabric 25.5" High

I100743-99-0

$557.00 Ergo Back Recline 16" W x 21" H Leatherette

I311108-00-90-0

$583.00 Ergo Back Recline 16" W x 21" H Fabric

I311108-00-80-0

$759.00 Ergo Back Recline 18"W Leatherette 25.5" High

I100747-99-0

$785.00 Ergo Back Recline 18"W Fabric 25.5" High

I100744-99-0

$759.00 Ergo Back Recline 18" W x 21" H Leatherette

I311110-00-90-0

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Backrest Options

$785.00 Ergo Back Recline 18" W x 21" H Fabric

I311110-00-80-0

$982.00 Rectangular Backrest 16 W

I10004

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

$1,147.00 Rectangular Backrest 18 W

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

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

I305510-00-80-0 Select Options:

$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

Seat Sizing

$595.00 Corpus Seat 17"W x 14"D No Cushion CMR

I100345-99-0

I100348-99-0

No Charge Corpus Seat 17"W x 18"D No Cushion CMR

I100353-99-0

I100359-99-0

I100365-99-0

I100354-99-0

$1,190.00 Corpus Seat 19"W x 20"D No Cushion CMR

I100360-99-0

$1,190.00 Corpus Seat 19"W x 22"D No Cushion CMR

I100366-99-0

$1,190.00 Special Seat Size 21"W x 18"D No Cushion

I10007

I10008

I10009

I10010

I10011

I10012 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

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Armrest Options

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 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

$239.00 20" Between Armrest w/ 18" Backrest

I10001

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.

$664.00 Armrest Supports HD

I308506-99-1

$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

Select Options:

$1,998.00 Power Articulating Elevating Legrest

I101279-99-0

No Charge Manual Adjustment Legrest Elevation

I101278-99-0

No Charge Calf Supports Leatherette

I100517-99-0

$10.00 Calf Supports Fabric

I100516-99-0

No Charge Legrest Assm. 2pc Footplates

I101276-99-0

$332.00 Legrest Assm. 1pc Footplate

I101277-99-0

$399.00 3" Width Between Two- Piece Footplates

I10006

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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

$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

$453.00 Long Thigh Supports Leatherette

I100513-99-0

$479.00 Long Thigh Supports Fabric

I100512-99-0

$453.00 Short Thigh Supports Leatherette

I100511-99-0

$479.00 Short Thigh Supports Fabric

I100510-99-0

$435.00 Abductor Kit

I100978-99-0

$552.00 Knee Block Assembly Corpus

I10015

$369.00 Transfer Handles

I100974-99-0

$297.00 Push Handles

I100975-99-0

$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

$166.00 Positioning Belt Retractable

I100519-99-0

$186.00 Positioning Belt Retractable Long

I100600-99-0

$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