Pride Mobility Products Corporation

380 Vansickle Rd. St. Catharines, ON L2R 6P7 Phone: (888) 570-1113 Fax: (866) 514-1303

J6 & J6 W/ PES
300 lbs. weight capacity Date: PO#: Account Number: Bill To: Address: Phone Contact: Ship To: Address: Marked For: Discount: Terms: Freight:

Order Form

SPECIFIED DIMENSIONS* Please supply patient information for optimal setup prior to shipping.

Client Height: Client Weight: A. Seat Width: B. Lateral Offset: C. Hip/Thigh Lateral Offset: D. Center of Gravity: Optimized based on seat dimensions E. Seat Depth: F. Back Height from Pan: G. Lateral Height from Pan: H. Armrest Height from Pan: I. Rigging Length (whole numbers only): J. Seat to Floor Height: qLow qMiddle qTall Clinician Notes: LOWEST SEAT-TO-FLOOR HEIGHTS
Seating Lowest Seat-To-Floor Contoured Seating 20.5 Specialty Seat 16.75 Synergy Seat 16.625 *(PES option adds approximately 1.5 to the lowest STF height listed.)

* While every effort will be taken to ensure items will be preset to your specifications prior to shipping, variations in options may effect final settings.

Revised: September 25, 2012

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BASE MODEL
Description

All prices are MSRP.

Order Form

Price $4295 $5095

CONTOURED SEATING
Medium Back:
Description Price Std NC qMed-Back qMed-Back with Solid Seat Pan2 Seat Width: q16 q18 Seat Depth: q16 q18 Upholstery: qBrown Vinyl qBeige Vinyl qBlack Vinyl qGray Fabric

qJ6 qJ6 w/ Power Elevating Seat Option 1 Jazzy Red Jazzy Blue

COLOR

DRIVE WHEELS
q10 Solid (pair) q10 Pneumatic (pair) Std NC Std NC

qGray Vinyl qBrown Fabric $70 $70

BASE MOUNTED FOOT PLATFORM

Base Mounted Foot Platform No Base Mounted Front Platform

High Back:

qLimited Recline High-Back with Headrest qLimited Recline High-Back with Headrest & Solid Seat Pan2 Seat Width: q16 $95 Seat Depth: q16 $95 Upholstery: qBrown Vinyl qBlack Vinyl q18 Std q18 $95 q20 $95 q20 Std

ELECTRONICS for non power elevating seat

75 Amp NE (not available w/ PES) Std

qBeige Vinyl qGray Fabric

qGray Vinyl qBrown Fabric $100

Depth Adjustable High Back:

ELECTRONICS 1 for power elevating seat

VSI 6-Key1 (required for PES) Std with PES

qLimited Recline Gray Vinyl Depth Adjustable High Back w/ Headrest q18W x 18-20D q20W x 18-20D

Armrests: Armpads:
Left: Right:

qFlip-Up, Removable qFlip-Up, Height-Adjustable, Removable qFull Length qFull Length

Std NC

BATTERY CHARGER
5 Amp Offboard Std

qDesk Length qDesk Length

MANUAL RECLINER
Armrests:
qManual Recliner High Back with Headrest qManual Recliner High Back with Headrest and Solid Seat Pan2 Upholstery: qBeige Vinyl qGray Vinyl Seat Width: q16 $95 q18 Seat Depth: q16 $95 q18 $695 $695

JOYSTICK MOUNTING BRACKETS

qFixed Inline qLeft qRight qSwing-away qLeft qRight qInline qOffset q4 Ext. q7 Ext. qMulti-axis Fixed qLeft qRight (Fixed configuration. Does not swing away) Std $250

$200

SPECIALTY SEAT

qSpecialty Seat Kit

$300

FOOTNOTES
1. Only Available with VSI 6-Key Joystick. Includes 1/4 Speed Inhibit. Raises Seat-ToFloor Height. NA with Synergy Manual Tilt or Recline. 2. Includes black vinyl seatpan. Back available in listed colors. 3. Call for configuration options with Shape Back 4. Flip-up arms may interfere with swing-away laterals 5. Adjustable from 11" to 17" in .5" increments 6. Not available with Waterfall Armpads

Seat Width: q16 q18 q20 Seat Depth: q16 q17 q18 q20 Back Cane Height: q18 q20 q22 Sling Back: q16 W q18 W q20 W

q19

$135

Armrests for Specialty Seating:

q2-Post, Fixed Height, Flip Back3,4 qFlip-Back, Cane Mounted3,4 qRemovable, Quick Height Adjustable5 qRemovable, Heavy Duty, Height Adjustable q8-12 Adjustment range q10-14 Adjustment range

NC $138ea $123ea $123ea

Armpads:
Left: Right:

qFull Length qFull Length

qDesk Length qDesk Length

Revised: September 25, 2012

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SYNERGY SEATING SYSTEMS

Description Price $995 $625 $925

Order Form
Description
Bracket:

POSITIONING COMPONENTS
q Stealth Thoracic Laterals (pair)
q Swing-Away Rail Mount Bracket

Price

qSynergy Seating Frame qSynergy Manual Recline Package1,2 qSynergy Manual Tilt Package1

Max. Seat Size 14W x 14D, 75 lbs Weight Capacity

Seat Width: q10 q11 q14 q15 q18 q19 Seat Width Package: q10W-14W q14W-18W Seat Depth: q10 q11 q14 q15 q18 q19 Seat Depth Package: q10D-14D q14D-18D Back Cane Height: q14" q15" q18 q19 q22 q23

Choose Pad:

(For Use With Synergy Back and Tru Comfort Back)

$500 $220 $220 $220 $220 $220

q12 q16 q20 q16W-20W q12 q16 q20 q16D-20D q16" q20 q24

q13 q17

q Flat Pad, 3 x 5 Leather-Like Cover q Flat Pad, 4 x 6 Leather-Like Cover q Curved Pad, 2 x 3 4-Way Stretch Cover q Curved Pad, 3 x 5 4-Way Stretch Cover q Curved Pad, 4 x 6 4-Way Stretch Cover

ARMRESTS for Synergy seat only

q13 q17 qFlip-back, Cane Mounted5 Std q2-post, Flip-back, Height-adjustable, Removable5 (9-13 of height adjustment in 1 increments) qSingle-post, Height-adjustable, Removable6 qQuad Release Lever qRemovable, Single-post, Height Adjustable, Heavy Duty q8H - 12H q10H-14H qPediatric, Removable7 $123ea Color: Match Shroud Black Quad Release Lever Std $85 $150 $195 $195

$138ea $123ea $123ea

qStandard Back Canes With Push Handles qStandard Back Canes, No Push Handles qFlip Forward Canes3 qOffset (Meso)4 q2 (1 Per Side) q4 (2 Per Side) qInset (Endo)4 q2 (1 Per Side) q4 (2 Per Side)

BACK CANE OPTIONS

q17" q21" q25

(7 3/4 - 9 3/4 height adjustment in 1/2 increments from seat pan to top of armrest)

qHeight-adjustable Cantilever Armrests (SOF) 8

Angle-Adjustable: - 30o through + 30o

$138ea

ARMPADS
qStraight, Full Length (2x14) qLeft qRight qStraight, Desk Length (2x10) qLeft qRight qWaterfall, Full Length (2x14) qLeft qRight qWaterfall, Desk Length (2x14) qLeft qRight Std NC NC NC

BACK OPTIONS

qSynergy Back with 1.5 Thick Back Cushion $450 Back Height: q18 q19 q20 q21 q22 q23 q24 q25 Lateral mounting rails: q6 extension/height (For back heights 13-16H) $25 q10 extension/height (For back heights 17-18H) $25 q12 extension/height (For back heights of 19H-22H) $25 q16 extension/height (For back heights of 23H-25H) $25 qSynergy Shape Backs

HEADRESTS
qNo Headrest Required TRU-Comfort 9 q8W TRU-Comfort Plus q10W TRU-Comfort Plus qRemovable Headrest Bracket

See Synergy Shape Back Order Forms For Detailed Pricing and Sizes

Various $135

$325 $325 $180

qSling Back qOmit Back q TRU-Comfort Back 4-way Stretch Material Cover
A with Specialty Seat. N Overall back height measured from top of seat pan to top of back +- 1/2 Width: Height:

Headrest measurement is taken from the inside of the headrest

q 16W q 18 W q 20W $695 q 20 H q 21 H q 22H q 23H q 24H q 25H q 27H q 28H q 17W q 19W $695 q 22H q 23H q 24H q 25H q 27H q 28H
NC $150

FOOTNOTES
1. N/A with Power Elevating Seat Option 2. Requires Solid Curved Back not included 3. Not available with Synergy Manual Recline, Synergy Manual Tilt, vent tray, bariatric armpads, Tru-Comfort or sling back. May interfere with with lateral supports and Waterfall Armpads. 4. Available with Tru Comfort seating only through SOF. Not available with Synergy Manual Recline. Flip Back armrests may interfere with offset canes. 5. Interferes with swing-away laterals. 6. Adjustable from 11"-17" in 1/2" increments 7. Desk Length armrests with an accessory may interfere with access to height adjustment lever. Adjustable Height from 7.75" to 9.75". 8. Height adjustment from 11-17" depends on cane height. Not available with Manual Recline, Flip Forward back canes, Cane Clamp Pushbar, & Shape Back. Call for details when selecting aftermarket arm troughs or Universal Swivel. 9. TRU-ComfortTM Headrests are measured at the front of the headrest

Width: Height:

Tru Comfort Colour Shroud Option: q Black (Standard color option) q Colour Match Base

Revised: September 25, 2012

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o

Price $270 Std

Order Form
Description Price $ 450 qHigh Mount Foot Platform q10-14 Ext.1

Description

STANDARD LEGRESTS

HIGH MOUNT FOOT PLATFORM

q14-17 Ext.1

q70 Swing-away Legrests

qStraight qTapered q Standard Extruded Footplates

Extensions Length: Footplates Size:

FRONT RIGGING ACCESSORIES

q11-13

q13-16.5

q15.5-19.5 $165

q7.25 x 6 q8.5 x 6 q Angle-Adjustable Footplates

Extensions Length: Footplates Size:

q11-13

q13-16.5

q15.5-19.5

qWheel Bumpers qHeel Loops (pair)2 qGel Neoprene Footrest Sleeve (pair)6 qELR/ALR Adductor Buttons (pair) qResidual Limb Support qLeft qRight (See Quantum accessories order form for additional options)

$25 $30 $120 $120 $275

q4 x 6 q5 x 6 q5 x 8 q6 x 84 q6 x 114 q8 x 115 q Multi-Axis Footplates

Extensions Length: Footplates Size:

$495

q11-16.5 q4 x 6 q6 x 84

q15.5-19.5 q5 x 6 q6 x 114 q5 x 8 q8 x 115 $450 $465 $420 Std

SYNERGY CUSHIONS
qNo Cushion Required
Please refer to Synergy order forms for detailed pricing and sizes.

qHigh Mount, Clamp-On Footrest

qAngle Adjustable qSmall, 4 x 7.75 qLarge, 4.25 x 9.25 qMulti-Axis qSmall, 4 x 7.75 qLarge, 4.25 x 9.25

qHeavy Duty Drop-In Legrests1,2

q Angle Adjustable Footplates

Extension Length: Footplate Size:

q12-14.5 q4 x 6 q6 x 84

q14.5 -18 q5 x 6 q6 x 114 q5 x 8 q8 x 115 $520

qElevating Legrests1
q Standard Footplates

Extension Length: Footplate Size:

q11-14

q14-17 $165

q7.25 x 6 q8.5 x 6 q Angle Adjustable Footplates Extension Length: q12-14.5 q14.5 -18 Footplate Size: q4 x 6 q5 x 6 q5 x 8 q6 x 84 q6 x 114 q8 x 115 3 q Calf Pad Adjustment q1 Hole q3 Hole q6 Hole

ACCESSORIES

Simplicity Cushion General Use q16 x 16 - 20 x 20 Solution 1 Cushion Skin Protection q14 x 14 - 20 x 18 q20 x 20 Solution Cushion Skin Protection & Positioning q10 x 10 - 18 x 22 q19 x 17 - 20 x 20 Solution 1 LTC Cushion Skin Protection & Positioning q14 x 16 - 20 x 20 Spectrum Gel Cushion Positioning q12 x 10 - 19 x 19 q20 x 16 - 20 x 20 Spectrum Visco Cushion Skin Protection & Positioning q10 x 10 - 19 x 19 q20 x 16 - 20 x 20 Spectrum Air Skin Protection q14 x 12 - 20 x 20 Spectrum Air Contour Skin Protection & Positioning q14 x 12 - 20 x 20 TRU-Comfort Seat Cushion General Use q16 x 16 - 20 x 20 qPlus 4-way stretch material cover $120 $120 $85 $85 $120 $32 $85 $225 $32 $28 $395 NC $175

$149 $269 $319 $399 $499 $525 $549 $599 $549 $599 $580 $680 $399

qPediatric Swing-Away Legrests1

q Angle Adjustable Footplates

Extension Length: Footplate Size:

$270 $165

q7-10

q4 x 6

q5 x 6

FOOTNOTES
1. 2. 3. 4. 5. 6. 7. 8. 9. Extensions are measured from top of seat pan to footplate Standard with angle adjustable footplates with heel loops. Available only with ELR's Available only on seats 18"W or greater Available only on seats 20"W Available only on swing-away legrests. Swing-away laterals interfere with flip back armrests. Includes mounting hardware. Not available with Tru Balance Manual Recline or Manual Recliner. Not available with manual recline, includes mounting hardware. Tru Comfort Back requires custom O2 holder, call for details.

qRear Basket8 qCane/Crutch Holder8 qOxygen Holder Contoured Seating8 qOxygen Holder Synergy Seat9 qWalker Holder8 qFlag Holder qStroller Handle Manual Tilt Only qWeather Cover, Medium, Black qCup Holder qLeft qRight qSaddle Bag q Tablet Holder10 q Cell Phone/Media Holder10 q Deluxe Cell Phone/Media Holder10

LAP BELTS
q38 Lap Belt q50 Lap Belt q60 Lap Belt q70 Lap Belt q80 Lap Belt q90 Lap Belt $24 $24 $24 $24 $24 $24 $180ea

10. Available with Synergy armrests only

BATTERIES
U-1, 32 Amp, Gel

Revised: September 25, 2012

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