Quickie 2 Lite Order Form - Quickie-Wheelchairs.com

2. FRONT SEAT HEIGHT SET UPooooooooooooooooCaster Size3"4"5"6"184SH42184SH12184SH13184SH14184SH15184SH16184SH17184SH18184SH20184SH21184SH23184SH24184SH26184SH27184CP11184CP12FrontHeight -SA FrontFrameoooooooooooooFront Seat Height14.5" (Only available on Fixed Front)15" (Only available on Fixed Front)15.5" (Only available on Fixed Front)16" (Only available on Fixed Front)16.5"17"17.5"18"18.5"19"19.5"20" (Max length for fixed front)20.5" (Only available on swing away)21" (Only available on swing away)Caster HousingStandardHemi Subtract 1 3/4 " fromStandard Front STFH MatrixFront Seat Height MatrixStandard Caster Housing (For Hemi Housing Subtract 2")Short Short Wide Tall WideFrog Legs+.5" None +.5" +.5" +.5" +1"Spacer None +1" +1" None +1" NoneFrontHeight -Fixed FrontFrameFork Hole Fork Hole Fork Hole Fork Hole16 1/2 15 1/2 Top17 16 Bottom Top Top17 1/2 16 1/2 Bottom Top Middle Top Top18 17 Bottom Bottom Middle Top Middle Top18 1/2 17 1/2 Bottom Middle Bottom Middle Top19 18 Bottom Bottom Middle19 1/2 18 1/2 Bottom17 16 Top Top17 1/2 16 1/2 Bottom Top Middle Top Top18 17 Bottom Top Bottom Middle Top Middle Top Top18 1/2 17 1/2 Bottom Bottom Middle Bottom Middle Top Middle Top19 18 Bottom Bottom Middle Bottom Middle Top19 1/2 18 1/2 Bottom Bottom Middle20 19 Bottom18 17 Bottom Middle Top18 1/2 17 1/2 Bottom Bottom Middle Middle Top19 18 Bottom Bottom Middle Bottom Middle Top Middle19 1/2 18 1/2 Bottom Bottom Middle Bottom Middle20 19 Bottom Bottom Middle20 1/2 19 1/2 Bottom19 18 Bottom Middle19 1/2 18 1/2 Bottom Bottom Middle20 19 Bottom Bottom Middle Bottom20 1/2 19 1/2 Bottom Bottom21 20 BottomNCNCNCNCNCNCNCNCNCNCNCNCNCNCNCNCoooooooooo184CW6184CW66Caster Wheels184CW1 3" Micro NC184CW34" Low Profile PolyurethaneNC184CW31 4" Micro Lighted $70.00184CW72 4" x 1" Aluminum Polyurethane $80.00184CW44 4" x 1.25" Semi Pneumatic $55.00184CW64 4" x 1.5" Aluminum Soft Roll $135.00184CW5184CF535" Low Profile Polyurethane NC184CW51 5" Micro Lighted $85.00184CW65184CW7184CW34184CW33184CF32E10155" x 1" Aluminum Polyurethane $100.005" x 1.5" Semi-Pneumatic $85.005" Soft Roll (Grey)NA w/ Frog LegsShort Wide Fork1.5" wide casterUsed with 1.25" orFrog Legs Suspension (0-100 lbs)Frog Legs Suspension (101-190 lbs)$85.005" x 1.5" Aluminum Soft Roll $145.00Tall Wide ForkNC$75.00184CW35 6" x 1.5" Semi Pneumatic $85.00184CW68E2214E22156" Polyurethane6" Pneumatic6" x 1.5" Aluminum Soft RollCaster Fork$160.00184CF46 Short Fork NC184CF54184CF55184OC1E1015E1015Frog Legs Suspension (191-265 lbs)Caster OptionsCaster Pin Locks NA w/ hemi casterhousing, frog legs, short wide fork184CF45 NCNC$395.00$395.00$395.00$195.00ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 2

3. HANGER & FOOTPLATE OPTIONSoooSwing - Away HangersFootplate mounts with Extension Tube using clamping hardware184H86 o 70° Swing In/Out Hanger NC184H116 o 80° Swing In/Out HangerNC184H32 o Omit Hanger and Footplate -$15.00See Extension matrix for leg length rangeooo184E1184E2184E5ShortMediumLongNCNCNCFrameTypeFixed FrontSwingAwayFootrestAngle70°80°70°80°Inset0°1°0°1°StdStdFootrest Extension TubesExtension MatrixFootrest Type and ExtensionComposite/AluminumPlatformTubular/AutofoldShort Med Long Short Long Short LongMin 13 3/4 13 3/4 14 3/4 13 1/2 15 1/4 12 12 1/4Max 17 1/2 19 1/2 20 1/2 16 1/2 21 16 1/2 18Min 13 3/4 15 16 1/4 13 1/2 16 3/4 12 13 1/2Max 17 1/2 19 1/2 20 1/2 16 1/2 21 16 1/2 18Min 14 1/2 14 1/2 15 1/2 14 3/4 16 1/2 13 13 1/4Max 17 1/2 19 1/2 21 1/2 18 22 1/2 17 3/4 19 1/4Min 14 1/2 15 17 14 3/4 18 13 14 1/2Max 17 1/2 19 1/2 21 1/2 18 22 1/2 17 3/4 19 1/4Min 11 1/4 12 1/4 13 1/4 11 1/4 13 3/4 10 10 3/4Max 15 1/4 17 18 1/4 14 1/4 18 3/4 14 1/4 15 3/4Min 11 1/2 12 1/4 14 11 3/4 15 10 1/4 11 3/4Max 14 3/4 16 3/4 18 1/2 15 19 1/2 14 3/4 16 1/4oooHeel loop or leg strap not included, See Footplate Options Sectiono 184F245 K0040o184F250184HL1K0040E0951Footplates184F1 Composite (13"-22"w) NC184F271 K0040 Composite Angle Adj (16"-22"w) $150.00184F3 K0040 Aluminum Angle Adj (16"-22"w)Tubular Flip UpFixed front frame onlyAuto Fold Angle AdjFixed front frame onlyFootplate OptionsLower Leg Length SettingRecommend 2" footrest clearance to ground surface$185.00184F48 K0040 Platform Flip Up $190.00$100.00$200.00Heel Loop $30.00184HL5 K0038 Leg Strap $35.00o 184LO07 12.0" NC o 184LO16 16.5" NCo 184LO08 12.5" NC o 184LO17 17.0" NCo 184LO09 13.0" NC o 184LO18 17.5" NCo 184LO10 13.5" NC o 184LO19 18.0" NCo 184LO11 14.0" NC o 184LO20 18.5" NCo 184LO12 14.5" NC o 184LO21 19.0" NCo 184LO13 15.0" NC o 184LO22 19.5" NCo 184LO14 15.5" NC o 184LO23 20.0" NCo 184LO15 16.0" NC o 184LO24 20.5" NCORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 3

4. REAR SEAT HEIGHT SET UP13" & 13.5" NA w/ transito 184RH11 13.0" NC o 184RH18 16.5" NCo 184RH12 13.5" NC o 184RH19 17.0" NCo 184RH13 14.0" NC o 184RH26 17.5" NCo 184RH14 14.5" NC o 184RH20 18.0" NC Wheel/Tire 13.0 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5o 184RH15 15.0" NC o 184RH27 18.5" NC 20" All X X X X X X X X NA NA NA NA NA NAo 184RH16 15.5" NC o 184RH21 19.0" NC 22" Poly NA NA X X X X X X X X NA NA NA NAo 184RH17 16.0" NC o 184RH37 19.5" NC 22" Pneu NA NA NA X X X X X X X X NA NA NANA NA NA NA X X X X X X X X NA NANA NA NA NA X X X X X X X X NA NASee availability matrix. Contact Built 4 Me for Spinergy color options 25" Kik NA NA NA NA X X X X X X X X NA NAo 184RW320" Mag WheelNC 25" All but Kik NA NA NA NA NA X X X X X X X X NAo 184RW822" Mag Wheel NC 26" All NA NA NA NA NA NA X X X X X X X Xo 184RW124" Mag Wheel NCo 184RW90 20" Lite Spoke Wheel $200.00WheelUltraMag Lite Spokeo 184RW91 22" Lite Spoke Wheel $200.00 TireLightweightSpinergyooo184RW92184RW93184RW9424" Lite Spoke Wheel25" Lite Spoke Wheel26" Lite Spoke WheelNCNC$80.00PneumaticPneumatic w/Airless InsertFull Poly Tire20,22,2420,22,2420,22,2420,22,24,2620,22,24,2620,22,2424,2624,26oooooooooooooooooo184RW77184RW78184RW28184RW95184RW96184RW97184RW32184RW98184RW99184RW40184RW50184RW25184RT1184RT21ooooE221124" Ultra Lightweight Spoke WheelOnly available w/ silver anodized handrimAirless Insert 184RT2E2211E2213 Pneumatic $80.00184RT3 E2218 Full Poly NC184RT6E2211High-Pressure ClincherE2212$95.00184RT27E2211E2212E2211E2212Rear Seat HeightRear Wheel Type22" Ultra Lightweight Spoke WheelOnly available w/ silver anodized handrim22" Spinergy SPOX Black $695.0024" Spinergy SPOX Black $695.0025" Spinergy SPOX Black $695.0026" Spinergy SPOX Black $695.0022" Spinergy LX Black $895.0024" Spinergy LX Black $895.0025" Spinergy LX Black $895.0026" Spinergy LX Black $895.0024" Mountain $250.00Omit Rear Wheel and Axle(Intended Size for Set Up ______ )Rear Wheel TireKnobby V-TRAK$250.00$250.00-$55.00Pneumatic NC$95.00$125.0024" Pneu24" All but PneuHigh Pressure Clincher 22,24,25,26 22,24Knobby V-TRAK 24Schwalbe MarathonKik Mako Blackooo24 24,25,2624,2522" = 489 mm 24" = 540 mmOmit HandrimNA on every rim22,2424,25Natural Fits available in 22", 24", and 25". Ultra lightweight wheels available w/alum ano handrim. Not all handrims available on all wheelso184HR31184HR24Rear Seat to Floor Height MatrixNote: These values are representative of a 16" seat depth with 1" of seat squeeze andstandard axle plate. Due to variances caused by seat angle, rear seat height ranges mayshift up or down by as much as 1/2". Call customer service or online configurator for moreinformation.ooo184HR4184HR30184HR8184HR7184AX1HandrimNatural Fit LT- Super GripSpinergy Flex Rim Available on24" & 25" Spinergy LX wheel22,24,25,2624,25,26184HR1 Aluminum Anodized NC184HR22184HR23184AX11Plastic Coated -NA on every rimNatural Fit - Standard GripNatural Fit - Super GripNatural Fit LT- Standard Grip8 Oblique NA w/ plastic coatedhandrims. Only available with 24" or 26 "Mag or Lite Spoke rims.AxleQuick Release SteelQuad Quick ReleaseMag and Mountain Wheel only24$95.00$375.00$395.00$375.00$395.00$525.00$240.00NCNC$90.00oo184RT22184RT12E2212 Schwalbe Marathon Plus EvolutionE2218 Kik® Mako Black $95.00E2211 Mountain Tire Only available$95.00E2212 on 24" Mountain Rear WheelORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 4

5. BACKRESToooo184BT10 Standard (9"-20") NC184BT84 o Angle Adjustable Back (3" & 4") $165.00See Matrix184AH1 3" Pivot Point Setting NC184AH2 4" Pivot Point Setting NCBack Height Settingo -14° o -12° o -9° o -7° o -1° o 0° o +4° o +5° o 184UX4 9" NC o 184UX14 14" NCooSelect desired setting o 184UX6 10" NC o 184UX16 15" NCo 184UX8 11" NC o 184UX18 16" NCo 184PH6 o Integral Push HandlesNC184UX12 13" NCoooooooo184PH11184PH5184PH2184PH12Back TypeFold-Down Push HandlesOnly available w/ Adj UpholsteryOmit Push Handles w/8° Medium &Tall only, NA w/ Angle Adj BackMilitary Service Patches (Optional)$25.00$100.00184BU1 Standard Upholstery NC184BU8Tension Adjustable Upholstery$175.00184BU14 Omit Back Upholstery -$15.00184JB01Angle Adjustable Back SettingPush HandlesIntegral Push Handles w/8°Medium &Tall only, NA w/ Angle Adj BackOmit Push HandlesBackrest UpholsteryJAY Back (Optional)J3 Back (See J3 Order Form)Price ListOnly available on tension adjustable upholstery and J3 Backooooooooooo184VU1184VU2184VU3184VU4184VU12184VU5184VU8184VU9184VU10184VU11184VU13Marines PatchArmy PatchNavy PatchAir Force PatchCoast Guard PatchPurple Heart PatchPurple Heart with Marines PatchPurple Heart with Army PatchPurple Heart with Navy PatchPurple Heart with Air Force PatchPurple Heart with Coast Guard Patch$90.00$90.00$90.00$90.00$90.00$90.00$145.00$145.00$145.00$145.00$145.00NCNC184B1184B5LowMediumBackrest184B9 Tall NCo 184UX10 12" NC o 184UX20 17"-21" NCBackTypeFixedAngle Adjustable(3" Pivot)Angle Adjustable(4" Pivot)PushHandlesIntegralFold DownOmitIntegralFold DownOmitIntegralFold DownOmitBackrest Height MatrixBackrestHeightLowMediumTallMediumTallLowMediumTallMediumLowMediumTallMedium17" max height for shippingAvailableHeight Range17"-20"12"-15"Tall 16"-19"LowMediumMediumTallLowLowMediumTall9"-12"13"-16"9"-12"13"-16"17"-20"13"-16"17"-20"N/A16"-19"13"-16"17"-20"N/A14"-17"18"-21"N/A17"-20"14"-17"18"-21"N/ANCNC6. ARMRESTSome limitations when used w/ angle adj back in the rear most settingE0973 Padded Swing-Away STD (9" to 13") $175.00o 184AA18Setting o 9" o 10" o 11" o 12" o 13"oooHeight Adjustable184AA11 oE0973 Single Post Hgt. Adj. Std (8.5"-13.5")oE0973 Single Post Hgt. Adj. Low (7"-11")184AA65 oE0973Flip Back Height Adj LITE (8.5"-13.5")oo184AA14184AM22Armpad for Height AdjustableSuggest using classic for tray tables. Contour only available w/ single postheight adjustable$260.00 184AM23 NC$260.00 184AM21$275.00Padded Swing Away Omit ArmrestOmit ArmrestDesk Length - Classic (10")Desk Length - Contour (10") 184AA29184AM24 Full Length - Classic (14")Full Length - Contour (14")NCNCNCNCORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 5

7. KEY OPTIONS & ACCESSORIESNo Gos may exist depending on wheel size and positiono 184A1 Quickie Backpack Black $55.00o 184WL1 o High Mount Push NC 184A2Quickie Kids Backpack Black$50.00ooo184WL2184WL27184WL30 oHigh Mount PullErgo ScissorCompactNC$100.00$125.00184A8Seat PouchQuickie Seat Pouch Black$45.00oo184WL10184WL12OmitDo Not MountNCNCAdditional Cover & Pack AccessoriesExtension Handleoo184A500184A994Gel Cover Hanger/FrameGel Cover Swing Away Arm$105.00$105.00Only available w/ high mount push or pull to lock wheel lockso 184EH7 E0961 Extension Handle (Pair)Only available w/ high mount push or pull to lock wheel locks on pneumatic orpneumatic w/ airless tire optionsoooo184AT1 oE0971 Rear Anti-Tip $135.00184SL6 o Omit Seat Sling -$15.00184CU1 oE2601 2" Cushion $95.00To order any JAY cushions on-chair, please see the JAY price list.Cushion name or part number must be filled out with desired width and depthJAY Bundled Cushiono184GA1184JC20E0974Width:Wheel LockGrade AidGrade Aid $150.00Anti-TipSeat SlingCushionJAY Cushions (Optional)Cushion Name or Part #Depth:Transit Option$60.00Price ListNA w/ padded swing away armso 184TO30 o Transit System $350.00ooooooooooooooooooo184A82184IG2184A54184A83184C36184C14184C35184C128184C6184C126184C116184C117184C103184C114Candy BlueCandy Purple184C127 Fuchsia NCMatte Green184C4 Midnight Purple NC184C5K0038CaddyGlowMiscellaneousMatte BlackPearl PinkRootbeerBackpackSparkle Silver$45.00Impact Guard Neoprene $85.00Extra Leg Strap BlackTool KitFrame Color$30.00$45.00184C2 Black NC184C10Black Opal184C38 Blue Opal NCCandy RedCopperForest Green184C113 Titanium Color Paint NC184C11 Toxic Green NC184C8 Yellow NCNCNCNCNCNCNCNCNCNCNCNCNCooooooSide Guard184SG33 oK0108 Plastic Standard (8.5" High) $125.00184SG29 oK0108 Plastic Low (6.5" High) $125.00Positioning Belts184A141 E0978 Belt 1.5" Auto Buckle w/Clamps $70.00 o 184C108184A117 E0978 Belt 2" Aircraft Buckle w/Clamps $110.00184A118 E0978 Belt 2" Aircraft Buckle Pad w/Clamp $120.00184A120 K0108 Positioning Belt Slide Clamps $50.00oCustom Frame Color184C112 Desert Camouflage $295.00184C43 Mossy Oak Camouflage $295.00184C42 Stars & Stripes $295.00Zebra (Choose above base color) Stdwith White unless above base paint ischosen NA w/ Black$295.00Spoke GuardsOnly available w/ Mag, Mountain, and Lite Spoke wheelsoo184A23184A302K0065K0065Black Spoke GuardsQuickie Clear Spoke Guards$115.00$115.00ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 6