Retail Prescription Form - Better Mobility
Retail Prescription Form - Better Mobility
Retail Prescription Form - Better Mobility
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<strong>Retail</strong> <strong>Prescription</strong> <strong>Form</strong><br />
OF-BREEZY-RELAX 2-RETAIL-03-10-2011-REV3<br />
Breezy RelaX 2<br />
Invoice to:<br />
Deliver to:<br />
Name:<br />
Name:<br />
Street:<br />
Street:<br />
Town: Postal code: Town:<br />
Country:<br />
Country:<br />
Tel: Fax: Tel: Fax:<br />
Order date:<br />
Marked for:<br />
Purchase order:<br />
Sunrise order no:<br />
• = Standard = Cost option ◦ = no cost option<br />
Customer service fax number : 01384 446644<br />
Email : orders@sunmed.co.uk Max. user weight: 145 kg<br />
Standard Specification<br />
RLX070008 8" solid (32 mm wide) castor RLX040230 Back height adj. 55 - 65 cm RLX060006 Elevating Legrest with angle (depth) adj. footplate<br />
RLX080709 Push to lock wheel lock RLX030012 Seat depth adj. 42 - 50 cm RLX020089 Colour: silver texture<br />
RLX040201 Seat height 45 cm RLX040028 std headrest (height/depth adj) Crash tested<br />
Base Price £1445 / €2351<br />
SEAT WIDTH<br />
RLX020106 ◦ 41 cm adjustable 37 to 43 cm (by std inner pads and space out option of armrest)<br />
RLX020109 ◦ 46 cm adjustable 42 to 48 cm (by std inner pads and space out option of armrest)<br />
RLX020111 ◦ 51 cm adjustable 47 to 53 cm (by std inner pads and space out option of armrest)<br />
£<br />
€<br />
SEAT DEPTH<br />
RLX030012 • 42cm (adjustable from 42 - 50 cm)<br />
SEAT HEIGHT (without cushion)<br />
RLX040201 • 45cm (8"/ 24": adj 45 - 49 cm; 8"/16" 45 cm)<br />
SEAT (tilting range -5° to 20° / 0° to 25°; factory setting 0-25°)<br />
RLX030107 • Comfort cushion anatomical shaped (7 cm)<br />
BACKREST RECLINE 0 - 35°<br />
RLX040027 • Comfort back anatomical shaped (lateral support)<br />
RLX040024 • Push handle height adjustable<br />
RLX040028 • Standard comfort headrest (height and depth adjustable)<br />
RLX040029 ◦ Cheek support headrest (3 wing, height, depth and lateral adjustable) (3 wing style)<br />
ARMREST<br />
RLX050022 • Height adjustable, detachable; with long comfort arm pad, length adj.<br />
FOOTREST<br />
RLX060007 • ELR, footplate angle adjustable.<br />
FRAME<br />
RLX090007 • Std. with stepper tubes and anti tips<br />
Page 1 / 2
OF-BREEZY-RELAX 2-RETAIL-03-10-2011-REV3<br />
Breezy RelaX 2<br />
£ €<br />
QUICK RELEASE REAR WHEELS<br />
RLX080403 ◦ 24", solid tyre, hand rim alu (5149) with drum brake & 8" inch castor ( SKU: SH 45 cm)<br />
RLX080409 ◦ 16", rear wheel solid with drum brake 8"inch castor (SKU: SH 45 cm with drum brakes only)<br />
WHEEL LOCK<br />
RLX080709 • Push to lock<br />
RLX080705 • Drum brake (SKU: with 16" / 24" rear wheels only)<br />
ACCESSORIES (Please note: The following accessories are placed into the box - they are not supplied fitted)<br />
RLX090117 Tray table 110.00 179.00<br />
RLX090118 • Tool kit<br />
RLX040920 ◦ Abduction pommel - removable<br />
RLX040910 ◦ Trunk support swing away/ detachable<br />
RLX090116 • Seat belt<br />
RLX090121 ◦ Space out kit (2 cm)<br />
RLX050027 Hemi armrest (length and angle adjustable) 71.00 116.00<br />
RLX090124 Stump pad LH 85.00 138.00<br />
RLX090125 Stump pad RH 85.00 138.00<br />
RLX090123 ◦ Standard hangers (pair)<br />
COLOUR<br />
RLX020089 • Silver texture<br />
Comments for special build:<br />
Breezy RelaX 2 - Base Price £1,445 € 2,351<br />
Option Price<br />
VAT<br />
Total Price<br />
Page 2 / 2<br />
For more information visit our<br />
website<br />
www.SunriseMedical.com
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