Order Form / Price List LifeStand LSC Compact 3 - Frank Mobility ...

US Distributor:www.lifestand-usa.come.mail : info@FrankMobility.comFRANK MOBILITY SYSTEMS, INC.1003 International DriveOakdale, PA 15071Toll Free: (888) 426-8581Fax: (724) 695-3710Fed. Tax ID# 25-1761112Order Form / Price ListLifeStandLSC Compact 3Adult + PediatricEffective 10/2/07Dealer InformationCompany: ______________________________Address:________________________________City: _______________ State:____Zip:_______Phone:__________________________Fax: ____________________________Purchase Order InfomationPO#: _________________________________Acct ID#: ______________________________Date: __________Contact:________________Customer Reference InformationName_________________________________ Age_______Gender_____ Height________Inches Weight_____________lbs.Seat Width of Current Wheelchair____________________InchesHandicap : Paraplegic Hemiplegics Tetra MS SEP Other _________Last standing session_____________________________________Date_______________ Rep’s name_________________________Contact person for questions on this order?___________________LSC Compact 3: Standing Wheelchair Fully Electric wtih Electric Backrest Standard.Includes:Electric wheelchair for inside and outside. Dynamic DX with Programmable Electronics. 2 motors of 180 W and 4 x 18 Ah Batteries. AutomaticBattery Charger. Rigid Frame made of steel and aluminum. Available in 4 seat widths and multiple ranges of seat depth. Seat canvas.Retractable Arm Rests can be converted to adjustable chest supports. Foot rests height can be adjusted. Tibia supports adjustable in height, ininclination and in width. Pneumatic rear wheel.Maximum user weight: 265 lbs Range approximately: 16 miles Maximum speed: 4.5 mph! Special Measurements !: All measurements have to be made with accuracy according to the diagram below:Choice(1)Retail PriceUS $LSC Compact 3 AdultRight Mount Control Unit - Long Seat- Long Arm Rest- Standard Cushion- Separate Footplates Left Mount Control Unit ◦$24,495.00LSC Compact 3 Kid- Short SeatRight Mount Control Unit - Short Arm Rest- Zoïd Cushion- Solid Single Footplate Left Mount Control Unit ◦$25,995.00SEAT WIDTH36 cm/14’’ ◦ 40 cm/16’’ ◦ 44 cm/18’’ ◦ 48 cm/20’’ ◦. . . . . THIGH LENGTHImportant! The measurement has to be made from the front of the kneecap to the back rest!Adult Back rest : cm 66 ◦ 64 ◦ 62 ◦ 60 ◦ 58 ◦ 56 ◦ 54 ◦ 52 ◦ Front of the chair: Inches 29’’ 28’’ 27’’ 26’’ 25’’ 24’’ 23’’ 22 “Pediatric 50 ◦ 48 ◦ 46 ◦ 44 ◦21’’ 20’’ 19’’ 18’’Measurement Note : If measuring with Varilite back rest, increase the depth by 2 cm◦ No Charge Option Standard Surcharge Options NA Not AvailableOptions left blank or not selected will be ordered with “ Standard” features.Prices subject to change without notice.

Order Form Page 2 of 4Effective 10/2/07◦ No Charge Option Standard Surcharge Options NA Not AvailableChoice(1)LEG LENGTHImportant! The measurement has to be taken from the sole of the foot to top of the knee!Retail priceUS $ 0Knee Cap: cm 39 ◦ 41 ◦ 43 ◦ 45 ◦ 47 ◦ 49 ◦ 51 ◦ 53 ◦ 55 ◦ 57 ◦ 59 ◦ FootplateInches: 15’’ 16’’ 17’’ 18’’ 19’’ 20’’ 21’’ 22’’ 23’’ 24’’ 25’’ANGLE KNEE SUPPORT ◦ ◦ ◦ARM RESTS°°°0ARM REST HEIGHT Important! Measure from the cushion to top of the armrest. This measurement has to beapplicable for the standing position!Bottom Topcm: 18 ◦ 20 ◦ 22 ◦ 24 ◦ 26 ◦ 28 ◦Inches: 7’’ 8’’ 9’’ 10’’ 11’’ 12’’ARM REST DEPTHImportant! Measure from the backrest to the curve of the armrest! Long Adult Version cm: 23 ◦ 25 ◦ 27 ◦ 29 ◦Inches: 9’’ 10’’ 11’’ 12’’°°°Short Pediatric Version cm: 17 ◦ 19 ◦ 21 ◦ 23 ◦Inches: 7’’ 8’’ 9’’ 10’’Long arm rest(Standard for LSC Pediatric) Short arm rest ◦BACK REST HEIGHTLSCLSC PedStandard (40 cm/16’’) $349Confort (48 cm/20’’) NABACK WHEELS (Standard)Ø 350 mm - 3.00 / 8’’ Inflatable tyreFRONT WHEELS (standard)Ø 200 mm - 8’’ Anti-punctureLSCChoice(1)LSCKidRetail priceUS $FRAME COLORBlack colourBlue ColourTitanium colourRed colour$245$245$245$245◦ No Charge Option Standard Surcharge Options NA Not AvailableOptions left blank or not selected will be ordered with “ Standard” features.Prices subject to change without notice.

OPTIONS Order Form Page 3of 4Effective 10/2/07Headrest – Including Fixation System $495Remove Tray Table $945Side Guard (pair)$410Arm trough (unit)Right Please indicate if left/right or both sides.Left Chest strap compulsory. Pair $510Gel Kneepads (pair) $135Knee Support Extensions (pair) $190Neoprene Large Kneepads (pair) $4454 Batteries Set (12 V x 18 Ah) Rotating Light $695Lighting Kit Kid Interco seat(for Adult, size 36cm/14’’ only)FOOPLATESeparate Footplate ◦ $4590Solid Mono Footplate $485Solid Mono Footplate Pediatric $485Extra Large Solid Mono Footplate.This is a low footplate adjustment. Note: Users are not able to drivein a standing position with this footplate.SEATS $645Varilite Cushions.* Please indicate size neededEvolution - Size : ________Zoïd – Size : ___________Seat Canvas - One piece tension adjustable without cushionNot compatible in size 36cm/14’’ $395 $395 NA $240Viscoelastic Foam Cushion $310BACKS AND TRUNK SUPPORTSEvolution Back Rest* Please indicate size neededStandard – Size:_________High – Size: ____________Deep – Size: ___________$445$505$675Swing Away Trunk Supports* For Varilite Evo Backs Only*Select Pads:*Indicate Pad Size:ShortLongOffset*Contoured Pads :_______*Linear Pads: ___________Trunk Support System (each)Right * Please indicate if you want left/right or both sides. Left * Not compatible with Varilite back rest Pair $320$320$320$80$80$1150◦ No Charge Option Standard Surcharge Options NA Not AvailableOptions left blank or not selected will be ordered with “ Standard” features.Prices subject to change without notice.

Order Form Page 3 of 4Effective 10/2/07BODYPOINT BELTSPlease circle size:Choice(1)Retail priceUS $Shoulder HarnessStandard:SM - MED - LG - XL $114 - $126Padded Hip BeltCenter Pull, Medial Four-PntXS - SM - MED - LG $104 - $118.Padded Hip BeltCenter Pull, Two-PointSM- MED - LG $58 - $106Padded Leg Harness SM - MED - LG $80Ankle XS - SM - MED - LG - XL $120 - $130Harness fixation kit - harness not included(square tube between push handles to fix H harness behind shoulders)VEST SUPPORT (ONE SIZE)TBDVest support for chest stability. Velcro adjustment. $450DYNAMIC CONTROL UNIT ON REQUEST- Attendant control unit- Dual control unit- Chin control unit- Sip and puff- Mini joystick control unit$750.00$950.00$1290.00$1770.00$2970.00Custom Requests:Sales Conditions:Prices are subject to change without notice. All LifeStand LS3, LSE3, LSA, LSC3 (Adult & Pediatric) and LSCM unitsare custom built to individual specifications. No returns. All deliveries are final.◦ No Charge Option Standard Surcharge Options NA Not AvailableOptions left blank or not selected will be ordered with “ Standard” features.Prices subject to change without notice.