Quantum Q6 Edge HD Light Rehab Seating Order Form · Deep Purple Lime Light Grey Street Midnight Blue Orange Crush Yellow Blaze Rim Color Optional. Rim colors other than the standard

Page 1 of 13INFINFB3573/RevG/02JUL2018

Q6 Edge® HD Order Form with Contoured and Synergy Seating

Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

Weight:________ Height:________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A. Shoulder Width: _______B. Chest Width: _________C. Hip Width: ___________

D. Max Sitting Height: ____E. Shoulder Height: ______F. Axilla Height: _________

G. Thigh Depth: _________H. Lower Leg Length: ____I. Elbow Height: ________

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. Com-plete the form by placing checks in the desired boxes and provide information in the interactive fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email. This order form contains a large variety of options to fulfill various patient needs. Descriptions and section notes, such as optional or required, are included to help you complete your order. Please contact Quantum Sales at 866-800-2002 if assistance is needed. Send the completed order form by fax (866-707-3422) or email ([email protected]). Incomplete forms may delay the quote or order. Customer service will contact you if the order is incomplete or if there are compatibility issues. If special order requests are needed, be sure that the Patient Information section is completed or include a completed physical assessment form with this order form. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for deter-mining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.

Thank you for choosing Quantum!

INTRODUCTION

PATIENT INFORMATION

1. BASE MODELREQUIRED. Select a group 3 power base. 450 lb. weight capacity with standard 4.7 mph programmable motors, 8 amp off board charger, and unoccupied transit loops. Dimensions of base without legrests: 26”Wx36.75”L.

Quantum Q6 Edge 3HD-SS .............................................$8,595Part: Q6 EDGEHD 3HD-SS. HCPCS: K0850Solid seat pan standard with no power option.

Quantum Q6 Edge 3HD-C ..............................................$8,595Part: Q6 EDGEHD 3HD-C. HCPCS: K0851Contoured Seat (Captain) Standard.

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http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_physical_assessment_form.pdf


Base Mounted Foot Platform ...................................... StandardPart: FRMASMB16077

Base Mounted, Bell Shaped Foot Platform ................... No ChargePart: RIGASMB7120041

Omit base mounted foot platform ............................. No ChargePart: PTOINDV3674

3" x 14” Run Flat Tires .............................................. StandardPart: PTOINDV3510

3" x 14” Flat Free Tires ........................................... No ChargePart: WHL124116 x2

3" x 14” Pneumatic Tires ......................................... No ChargePart: WHL124117 x2

4”W Flat Free, Knobby, Extended ........................... $275.50 ea.Traction TiresPart: WHL121698 x2

4”W Pneumatic, Knobby, Extended ......................... $275.50 ea.Traction TiresPart: WHL121703 x2

Account Number: ___________ Date: ________________ Marked for: _____________________________________2. BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.

Red CorvettePart: DGN169178-PRD1

Electric BluePart: DGN169178-PBU9

Back in BlackPart: DGN169178-PBK1

White SatinPart: DGN169178-PWT2

Pretty in PinkPart: DGN169178-PPK3

Deep PurplePart: DGN169178-PPR5

Lime LightPart: DGN169178-PGN7

Grey StreetPart: DGN169178-PSL3

Silver BulletPart: DGN169178-PSL7

Midnight BluePart: DGN169178-PBU10

Orange CrushPart: DGN169178-POR6

Yellow BlazePart: DGN169178-PYL3

Military GreenPart: DGN169178-PGN8

To Be DeterminedPart: N/A

3. BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. May interfere with seat mounted legrests.

4. DRIVE WHEELSREQUIRED. Select a type of drive wheels and accent color. Knobby tires increase overall base width by 1.5”.

4.2. Drive Wheel Accent ColorOptional. Not available with knobby tires. Sold in Pairs (parts below will be quantity of 2).

4.1. Drive Wheels

Match to Base ColorPart: Configuration selection, see specific part below

Non-matching ColorPart: Configuration selection, see specific part below

Back in Black ........................ $24.98 ea.Part: DGN164245-PBK1 x2

Red Corvette ........................ $24.98 ea.Part: DGN164245-PRD1 x2

Electric Blue ........................ $24.98 ea.Part: DGN164245-PBU9 x2

White Satin .......................... $24.98 ea.Part: DGN164245-PWH2 x2

Pretty in Pink ....................... $24.98 ea.Part: DGN164245-PPK3 x2

Deep Purple ......................... $24.98 ea.Part: DGN164245-PPR5 x2

Lime Light ........................... $24.98 ea.Part: DGN164245-PGN7 x2

Grey Street .......................... $24.98 ea.Part: DGN164245-PSL3 x2

Silver Bullet ......................... $24.98 ea.Part: DGN164245-PSL7 x2

Midnight Blue ....................... $24.98 ea.Part: DGN164245-PBU10 x2

Orange Crush ....................... $24.98 ea.Part: DGN164245-POR6 x2

Yellow Blaze ......................... $24.98 ea.Part: DGN164245-PYL3 x2

Military Green ...................... $24.98 ea.Part: DGN164245-PGN8 x2

To Be DeterminedFollow-up required.

7. FENDER LIGHTSOptional. Fender lights operate by pressing included single switch button. Fender lighting is not available with NE 4-Key Joystick or Single Actuator Control through Toggle Box.

5. POWER BASE CONFIGURATION FOR CONTOURED SEAT, SEAT TO FLOORREQUIRED with contoured seating.

6. OCCUPIED TRANSIT, WC-19Optional. Synergy Seating only with widths 20" to 24".

Fender Light Switch Mount TypeSide Rail/Track Mount Bracket .................................. No ChargePart: MEC1800866Allows the egg switch to be mounted to seating side rails using a t-nut assembly. This may also be mounted to TRU-Balance 3 flip-back arm-rest and other seat or accessory bar rails. Not available with con-toured seating.

Under Armrest Mounting Bracket ......................................$25*Part: MEC1802726*No charge with contoured seating. Allows the egg switch to mount to a joystick tube-style bracket mounted to any armrest. Includes joystick mounting bracket.

8. FULL LIGHT PACKAGEOptional. Not available with contoured seating. Requires NE+ 8 Key or Q-Logic 3 Joystick for Full Light Package.

Switch Fender Lights ......................................................................................................................................................$250Part: DGN154117

Lowest Seat to FloorPart: PTOINDV3558

Middle Seat to FloorPart: PTOINDV3559

High Seat to FloorPart: PTOINDV3560

WC-19 Occupied Transit Option ........................................ $275Part: KITASMB1830

To determine if your chair is WC-19 compliant (occupied), please re-fer to this website: http://wc-transportation-safety.umtri.umich.edu/crash-tested-product-lists/wheelchairs

Seat Mounted, LED, Full Light Package ...............................................................................................................................$995Part: ELE131477


Account Number: ___________ Date: ________________ Marked for: _____________________________________

NE+ 6 Key Joystick

NE 4-Key Joystick ....................................StandardPart: CTLDC1554No actuator control.

NE+ 6-Key Joystick (2 Actuators) .....................$200Part: CTLDC1560Control up to 2 actuators through joystick.

NE+ 8-Key Joystick (2 Actuators) ......................$400Part: CTLDC1561Control up to 2 actuators and LED, Full Light Package through joystick.

No Joystick, Setup for NE+ Joystick ...........No ChargePart: Configuration selection

Q-Logic 3 EX Controller Module .......................$695Part: See XRef. HCPCS: E2377

Q-Logic 3 Expandable Controller ......................$425Harness Part: HAR144005. HCPCS: E2313

Q-Logic 3 EX Joystick .................................................... $700Part: CTL167724

Q-Logic 3 EX Joystick for LED, Full Light Package ................. $700Part: CTL167725

No Joystick, Setup for Q-Logic 3Part: Configuration selection.

Black, Soft Touch ....................StandardPart: DGN124307

Non-matching Shroud ......................$50Part: PTOINDV3422Select color below

Match Shroud ................................$50Part: PTOINDV3421




White SatinPart: DGN124336-PWH2









Q-Logic 3 EX Joystick

9.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.

1. Q-Logic 3 Required ComponentsQ-Logic 3 expandable controls require the controller module and expandable harness below. If a Q-Logic joystick or specialty control is selected later in this form, Customer Service will quote the order with these items.

9.1b. Expandable Controls - Quantum Intelligent Systems™Select expandable controls or omit selection if another controller type is desired. Expandable controls allow multiple or specialized controllers.

2. Q-Logic 3 Joystick

3. Q-Logic 3 Joystick ArmorREQUIRED with Q-Logic 3 EX Joystick selection above. Reference colors shown in section 2.

9.2. SCIM ModuleOptional.

SCIM Module Kit for Q-Logic 3......................................................................................................... $525Part: CTL168055Allows use of joystick display for specialty devices. Available with Q-Logic 3 EX Joystick selection above. Up to 5 profiles to control drive, seat, and auxiliary functions, excluding sip-n-puff and single switch functions. A switch is required to operate the input device attached to the SCIM module. SCIM Module

10. JOYSTICK HANDLESOptional. The NE/NE Plus joysticks are standard with a carrot handle (See A in image). The standard Q-Logic 3 joystick knob can be seen in the image in section 7.1b. The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.

Joystick Handles

Mushroom Handle (B) ..................................... $85Part: ACCASMB1860. HCPCS: E2323

Chin Cup (C) ................................................. $85Part: ACCASMB1861. HCPCS: E2323 (E2324 when chin control)

T-Bar (D) .................................................... $120Part: ACCASMB1858. HCPCS: E2323

Medium Ball Handle (E) ................................... $65Part: ACCASMB1859. HCPCS: E2323

Soft Ball Handle (F) ........................................ $65Part: ACCASMB1856. HCPCS: E2323

Extended I-Handle (G) .................................... $85Part: ACCASMB1857. HCPCS: E2323

Bodypoint 3” Goal Post Handle ......................... $99Part: PLSKNCP1057. HCPCS: E2323

Bodypoint 4” Goal Post Handle ......................... $99Part: PLSKNCP1058. HCPCS: E2323

Q-Logic 3 Carrot Handle (A) .....................No ChargePart: DGN124308

9. ELECTRONICSREQUIRED. Select a type of drive control from the following sections. The No Joystick option is used to omit the joystick and utilize another control, such as a specialty control at the end of this form or found on the Alternative Controls and Electronics Order Forms.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf



Omit Joystick Mounting Bracket

Fixed, In-line, Bracket .............................................. StandardQ-Logic Part: FRMASMB10617. NE/NE+ Part: FRMASMB12744

Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

Swing-away, Inline, Left Side Mount ..................$245Part: See XRef. HCPCS: E1028

Swing-away, Inline, Right Side Mount ................$245Part: See XRef. HCPCS: E1028

Swing-away, 1” Offset, Left Side Mount .............$245Part: See XRef. HCPCS: E1028

Swing-away, 1” Offset, Right Side Mount ............$245Part: See XRef. HCPCS: E1028

Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

11.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline bracket" is used with track/TRU-Balance 3 style arms when the joystick is inline with armpad. "Inline bracket" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.

11.1a. Fixed, In-line Joystick Bracket

11. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.

11.1c. Specialty Joystick MountsSelect a bracket and side to mount it.

Specialty Mount Side

Retract4 Mount ............................................$350NE/NE+ Part: MEC138876. HCPCS: E1028Q-Logic Part: MEC138860. HCPCS: E1028Full 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold away. Joy-stick orientation varies as bracket is adjusted.

Multi-axis Mount ..........................................$100NE/NE+ Part: ACC142528. HCPCS: E1028Q-Logic Part: ACC131216. HCPCS: E1028Allows height adjustment of joystick.

Stealth Swing-Away/Flip Down Bracket ........... $294.25SAJ Part: ST-TWBM480CJ-Q. HCPCS: E1028Q-Logic Part: ST-TWBM480QL-Q. HCPCS: E1028Not available with contoured seat. Allows the joystick to pivot to side of armrest, or flip-down if bracket is ad-justed.

Swing Away JoystickInline Mount (Right)

Swing Away JoystickOffset Mount (Right)

Multi-Axis JoystickMount

Retract4

Swing-Away/Flip DownBracket (Stand Alone

Hardware Shown)

12. ELECTRONICS ACCESSORIESOptional.

Q-Logic EX/NE Programmer ............................................ $545Part: ELEASMB6976

Q-Logic PC Programming Disk with Cable ........................... $750Part: ELEASMB5216

20”Wx16”D .......................... No ChargePart: SETASMB2780

20”Wx22”D ......................... No ChargePart: SETASMB4889












20”Wx18”-20”D with 60" Lap Belt ............................. No ChargePart: SETASMB6896

22”Wx20”-22”D with 70" Lap Belt ............................. No ChargePart: SETASMB6897

13. CONTOURED SEATINGOptional. Select only one seating system. Special order seat sizes can be requested by checking the seat type and writing in the seat size in the special order seat size.

13.1a. Captain Style Seating1a. Depth Adjustable High Back with Limited Recline Full length armrests must be selected with a depth adjustable high back.

1b. High Back with Limited Recline

1c. Pinchless Hinge High Back

1d. Heavy Duty High BackSeat includes a lumber cutout, static hinges, and a Synergy Seat frame.

26”Wx18”D .................................$450Part: SETASMB4565

26”Wx20”D.................................$450Part: SETASMB4566

26”Wx22”D .................................$450Part: SETASMB4567

26”Wx24”D .................................$450Part: SETASMB4568

26”Wx26”D .................................$450Part: SETASMB4569

26”Wx28”D .................................$450Part: SETASMB4570

28”Wx18”D .................................$450Part: SETASMB4571

28”Wx20”D ................................$450Part: SETASMB4572

28”Wx22”D ................................$450Part: SETASMB4573

28”Wx24”D ................................$450Part: SETASMB4574

28”Wx26”D .................................$450Part: SETASMB4575

28”Wx28”D ................................$450Part: SETASMB4576

Contoured seating section continued on following page.














13.1b. Contoured Seat with Solid Seat Pan1a. High Back with Limited Recline and Solid Seat Pan

1b. Pinchless Hinge High Back with Solid Seat Pan





26”Wx18”D ............................... $1000Part: SETASMB5478

26”Wx20”D............................... $1000Part: SETASMB5479

26”Wx22”D ............................... $1000Part: SETASMB5480

26”Wx24”D ............................... $1000Part: SETASMB5481

26”Wx26”D ............................... $1000Part: SETASMB5482

26”Wx28”D ............................... $1000Part: SETASMB5483

28”Wx18”D ............................... $1000Part: SETASMB8484

28”Wx20”D .............................. $1000Part: SETASMB8485

28”Wx22”D .............................. $1000Part: SETASMB8486

28”Wx24”D .............................. $1000Part: SETASMB5487

28”Wx26”D ............................... $1000Part: SETASMB5488

28”Wx28”D .............................. $1000Part: SETASMB5489

1c. Heavy Duty High Back with Solid Seat PanSeat includes a lumber cutout, static hinges, and a Synergy Seat frame.

2. Armpads for Bariatric/Heavy Duty ArmrestsRequired with bariatric or heavy duty armrests

1. Bariatric/Heavy Duty Armrests

13.1c. Special Order Contoured SeatComplete information below. Contact inside sales specialist for pricing.

Depth:______Width:______Type of Seat:____________________________________________________

13.2. Contoured Seat Flip-Up, Height Adjustable, Removable ArmrestsREQUIRED and only available with non-heavy duty, High-Back seat. Depth Adjustable High-Back must select full length armrests. Select a Left and Right Armrest or to Omit them.

13.3. Heavy Duty, Contoured Seat, Removable ArmrestsREQUIRED and only available with heavy duty High-Back seats. Select armrests and armpads. Heavy duty armrests are sold in pairs.

Full Length, Left Armrest .................................................$85Part: FRMASMB8614. HCPCS: E0973

Desk Length, Left Armrest ................................................$85Part: FRMASMB8612. HCPCS: E0973

No Armrest ............................................................ StandardPart: N/A

Full Length, Right Armrest ................................................$85Part: FRMASMB8615. HCPCS: E0973

Desk Length, Right Armrest ..............................................$85Part: FRMASMB8613. HCPCS: E0973

Bariatric, HD, Height Adjustable, Full Length, ............... StandardRemovable 8"H-12"HLeft part: FRMASMB6728. Right part: FRMASMB6729

Bariatric, HD, Height Adjustable, Full Length, ................ StandardRemovable 10"H-14"HLeft part: FRMASMB6730. Right part: FRMASMB6731

Heavy Duty, Height Adjustable, Full Length, ...................$85 ea.Removable 8"H-12"HLeft part: FRMASMB9982. Right part: FRMASMB9983. HCPCS: E0973

Heavy Duty, Height Adjustable, Full Length, ...................$85 ea.Removable 10"H-14"HLeft part: FRMASMB9986. Right part: FRMASMB9987. HCPCS: E0973

Bariatric Armpads ................................................. No ChargePart: UPSASMB1027Only for use with Bariatric Armrests.

No Armpad .......................................................... No ChargePart: N/A

Straight Armpads ................................................... No ChargePart: UPSASMB1021Only for use with Heavy Duty Armrests

Waterfall Armpads ................................................. No ChargePart: UPSASMB1024Only for use with Heavy Duty Armrests

14. SYNERGY SEATING SYSTEMOptional. Widths, depths, and heights are available in 1" increments in the noted ranges. Maximum seat size 28"W x 32"D.

14.1. Synergy Frame Selection

14.2. Seat Dimension - WidthREQUIRED with Synergy seating. Part number is SETWDTH plus number following # below.

Synergy Seating Frame ...................................................................................................................................................$434Part: PTOINDV2995

20” Wide(#1010)

21” Wide(#1011)

22” Wide(#1012)

23” Wide(#1013)

24” Wide(#1014)

25” Wide(#1056)

26” Wide(#1054)

27” Wide(#1057)

28” Wide(#1055)

Synergy seating section continued on following page.

13. CONTOURED SEATING continued



14.3. Seat Dimension - Width PackageREQUIRED with Synergy seating.

20”-24” Width PackagePart: MEC120262



14.5. Seat Dimension - Depth PackageREQUIRED with Synergy seating.

14.4. Seat Dimension - DepthREQUIRED with Synergy seating. Part number is SETDPTH plus number following # below.

15”-20” Depth PackagePart: FRMASMB7732



15” Deep(#1005)

16” Deep(#1006)

17” Deep(#1007)

18” Deep(#1008)

19” Deep(#1009)

20” Deep(#1010)

21” Deep(#1011)

22” Deep(#1012)

23” Deep(#1013)

24” Deep(#1014)

25” Deep(#1060)

26” Deep(#1061)

27” Deep(#1062)

28” Deep(#1063)

14.6. Synergy Back OptionsREQUIRED with Synergy seating. See the Synergy and TRU-Comfort back availability chart for stock order back size ranges. Back widths larger or smaller than seat widths on the availablity chart are allowed with endomorph or mesomorph back canes.1. Back Selection

Synergy Back ............................................................... $275Part: See XRefSelect a back cane type and height and back height.

TRU-Comfort 4-way Stretch, 20” Width or less .................... $675Part: See XRef. HCPCS: E2620Select back height.

TRU-Comfort 4-way Stretch, 22” Width or greater ............... $775Part: See XRef. HCPCS: E2621Select back height.

HD Sling Back ................................................................$98Part: See XRefSelect a back height. Available with 24"-28" Width and 18"-25" overall heights. Back cane height must match back height. Not available with flip up cantilever arms.

Omit Back ............................................................ No ChargePart: PTOINDV1287Select a back cane type and height in following section.

Back Width

Synergy and TRU-Comfort Back Availability Chart

Ove

rall

Hei

ght

Synergy Back Synergy/TRU-Comfort BackTRU-Comfort Back

2. Back Cane Selection

3. Synergy Push HandlesPush Handles .......................................................... StandardPart: Configuration selection with back cane height

Back Canes without Push Handles (pair) .....................$62.50 ea.Part: Configuration selection with back cane heightNot available with Sling Back. Minimum cane height is 16".

Synergy Back Cane ................................................ No ChargePart: FRMASMB15844. Sling part: FRMASMB17096. Transit Part: FRMASMB15845Select a back cane height. Back width will be the same as seat width.

2” Mesomorph (1” per side) Back Cane ...............................$195Part: FRMASMB16387. Transit part: FRMASMB12067 Select a cane height. Back width will be 2" larger than seat width.

4” Mesomorph (2” per side) Back Cane ...............................$195Part: FRMASMB16390. Transit part: FRMASMB12091Select a cane height. Back with will be 4" larger than seat width.

2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB16393. Transit part: FRMASMB12115Select a cane height. Back width will be 2" smaller than seat width.

4” Endomorph (2” per side) Back Cane ...............................$195Part: FRMASMB16396. Transit part: FRMASMB12139Select a cane height. Back width will be 4" smaller than seat width.

5. Synergy Overall Back HeightRefer to the Synergy and TRU-Comfort back availability chart for stock order back size ranges. Parts: See XRef, configuration selection with back selection.

4. Synergy Accessory BarAccessory Bar ............................................................................................................................................................... $10012"W-16"W Part: MEC145955. 16"W-20"W Part: MEC143975. 20"W-22"W Part: MEC146018

17” H 18” H 19” H 20” H 21” H 22” H 23” H 24” H 25” H 27” H 28” H

Synergy seating section continued on following page.

14. SYNERGY SEATING SYSTEM continued



14.7. Synergy ArmrestsREQUIRED with Synergy seating. Left (L) and right (R) boxes may be checked to configure different size arms within one section arm type.

6. Synergy Back Cane HeightOmit this selection if a TRU-Comfort back is selected. 16" and 17" back canes are not available with a Synergy Back and cane mounted, flip up armrests. 14" and 15" back canes are not available without push handles. Parts: See XRef, configuration selection with push handles selection.

14” High Canes15” High Canes






Full Length, Heavy Duty Armrests, 8"-12" H ................$85 ea.Left part: FRMASMB9982. Right part: FRMASMB9983.HCPCS: E0973

Desk Length, Heavy Duty Armrests, 8"-12"H ................$85 ea.Left part: FRMASMB9984. Right part: FRMASMB9985.HCPCS: E0973

Full Length, Bariatric Armrests, 8"-12" H ................ No ChargeLeft part: FRMASMB6728. Right part: FRMASMB6729

Full Length, Bariatric Armrests, 10"-14"H ............... No ChargeLeft part: FRMASMB6730. Right part: FRMASMB6731.

Full Length, Heavy Duty Armrests, 10"-14"H ................$85 ea.Left part: FRMASMB9986. Right part: FRMASMB9987.HCPCS: E0973

Desk Length, Heavy Duty Armrests, 10"-14"H ..............$85 ea.Left part: FRMASMB9988. Right part: FRMASMB9989.HCPCS: E0973

Full Length, Cantilever Armrests .......................... $97.50 ea.Left part: FRMASMB16188. Right part: FRMASMB16189

Desk Length, Cantilever Armrests ......................... $97.50 ea.Left part: FRMASMB16190. Right part: FRMASMB16191

1a. Bariatric, Single Post, Heavy Duty, Height Adjustable, Removable ArmrestsOnly available with bariatric armpads.

1b. Single-Post, Heavy Duty, 8"-12" Height Adjustable, Removable Armrests

1c. Single-Post, Heavy Duty, 10"-14" Height Adjustable, Removable Armrests

1d. Height Adjustable, Cantilever ArmrestsHeight adjustment from 11"-17" depends on cane height. Not available with manual recline, flip forward back canes, or cane clamp pushbar.

14.8. Synergy ArmpadsREQUIRED with armrest selection above. Waterfall armpads may cause interference with the seat back. Armpads are configured as pairs.

14.9. Joystick Bracket ReceiverREQUIRED.

Bariatric Armpads ................................................. No ChargePart: UPSASMB1025.Only available with Bariatric Armrests.

Straight Armpads ................................................... No ChargeDesk/Desk part: UPSASMB1022. Full/Full part: UPSASMB1021. Desk/Full part: UPSASMB1023Not available with bariatric armrests.

Waterfall Armpads ................................................. No ChargeDesk/Desk part: UPSASMB1025. Full/Full part: UPSASMB1024. Desk/Full part: UPSASMB1026May cause interence with seat back. Not available with bariatric arm-rests.

Omit Synergy Armpads ........................................... No ChargePart: PTOINDV1373

Standard Fixed Receiver ........................................... StandardPart: FRMASMB16062

Stealth Height Adjustable Receiver ................................... $214Tube Arm Part: ST-ARM250C-Q. HCPCS: K0108

Height AdjustableReceiver (Track Arm)

Height AdjustableReceiver (Tube Arm)

14.10. Synergy Seat to FloorREQUIRED with Synergy seating.

16.5”Part: PTOINDV1888



15.1a. Standard Lap Belts38” Lap BeltPart: ACCBELT1006

50” Lap BeltPart: ACCBELT1000





i-Fit 60” Single Pull, Push Button, Medium ...........................$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q

i-Fit 60” Single Pull, Push Button, Large ..............................$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q

i-Fit 60” Single Pull, Push Button, Extra Large ......................$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q

60” Sure-Lok Lap Belt (Non-retractable) ............................ $120Required with WC-19 Transit Option.Part: ACCBELT1016

15.1b. Optional Lap BeltsNot available with contoured seating.

15. LAP BELTSREQUIRED except with select contoured seats with included lap belt. Select one lap belt below.

14. SYNERGY SEATING SYSTEM continued



Stealth’s Worlds Best Removable ..................$220.50Headrest Bracket (C)Part: FRMASMB15999. HCPCS: E1028

Stealth Removable Headrest Bracket (D) .......... $160.50Part: HDWASMB1084. HCPCS: E1028

Pediatric Offset (HMO475P-17) (E) ................$160.50Part: HDWASMB1166. HCPCS: E1028

Stealth 8” Comfort Plus ............................. $151.94Part: POS148484. HCPCS: E0955

Stealth 10” Comfort Plus (A) ....................... $151.94Part: SETHEAD1057. HCPCS: E0955

Stealth 14” Comfort Plus ............................ $151.94Part: INDPART2327. HCPCS: E0955

Pediatric Comfort Plus (6”Wx4.5”H) ............. $151.94Part: SETHEAD1069. HCPCS: E0955

Stealth Small Contoured (9.75”Wx3”H) ........... $64.20Part: SETHEAD1052. HCPCS: E0955

Stealth Large Contoured (11”Wx6”H) (B) ...........$80.25Part: SETHEAD1053. HCPCS: E0955

Headrests

16.1. Headrest Pads

16.2. Headrest Brackets

16. HEADRESTSOptional. Select a headrest pad and bracket. Not available with contoured seating.

17. SYNERGY SEAT WITH POWER AFP OPTION ELECTRONICSREQUIRED for Synergy Seat with articulating foot platform.

One Actuator Control (Articulating Foot Platform) .............. $1,895through NE+ JoystickPart: ELEASMB6430. HCPCS: E2310

One Actuator Control (Articulating Foot Platform) .............. $1,895Through Q-Logic 3 ElectronicsNo fender lights part: ELE1705592. With fender lights part: ELE1705562. HCPCS: E2310

18.1. Center Mount Foot PlatformIf power articulating foot platform is selected, be sure power legrest control has been selected in earlier section. Select legrest length in following section. Not available with contoured seating.1. Foot Platform Assembly

Power ArticulatingFoot Platform

No interference issues at this seat-to-floor height.

May have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.

Center Mount Foot Platform Compatibility Matrix

Synergy SeatLow Medium High

10”-16” Length Extension

13”-19” Length Extension

Power Articulating Foot Platform .................. $2,995Part: PTOINDV3754. HCPCS: E1012

Manually Adjustable Center Mount ...................$250Foot PlatformPart: RIG163640

2. Lower Extension and Footplates

3. Center Mount Calf Support*Calf pads are standard with a power articulating foot platform. Select calf pads covers for additional charge. Calf pad and panel covers include 1/2” of soft visco foam.

4. Modular Footplate Extension ComponentsOptional. Assembly required. May require seating configuration adjustments to avoid front caster interference.

8"-12" Extension, 5"x6" FootplatesPart: RIG152577Not available with power AFP.

8"-12" Extension, 5"x8" FootplatesPart: RIG152578Not available with power AFP.

10"-16" Extension, 5"x6" FootplatesPart: RIG150206






Small Calf Pads (pair) 6”Wx6”H ........................................ $150*Part: RIGASMB7120018

Large Calf Pads (pair) 8” taper to 6”Wx8”H ........................ $150*Part: RIGASMB7120019

Small Calf Panel 18”Wx8”H ............................................. $150Part: FRMASMB7110012

Large Calf Panel 24”Wx8”H ............................................ $200Part: RIG123824Only available on widths of 20” or greater.

Width Extension for 8”D Footplates ...................................$50Part: RIG152517

Width Extension for 11”D Footplates ..................................$50Part: RIG152518

2” Bell-Shaped Length Extension .......................................$50Part: RIG152519Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.

4” Outside Edge (pair) .....................................................$50Part: RIG152510Only available with 6”D footplates and 8”D footplate extension.

6” Outside Edge (pair) .....................................................$50Part: RIG152516Available with 8”D and 11”D footplates and 11”D footplate extension.

5. Additional AccessoriesReversed Dartex Calf Pad Cover (pair) ............................... $150Small part: RIG133717. Large part: RIG133719

Reversed Dartex Panel Cover (pair) .................................. $150Small part: RIG134673. Large part: RIG134744

Wheel Bumpers (pair) ............................................. $12.50 ea.Part: WHLASMB1578

Footplate Connector ....................................................... $15Part: RIGASMB7120023

Legrests section continued on following page.

18. LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.



18.2. Heavy Duty, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.1. Drop-In Legrest Selection

2. Angle Adjustable Footplate(s) with Heel Loops

3. Accessories

70° HD Drop-in with 12"-14.5" ........................ No Charge Length Lower Extension

Pair part: FRMASMB4762. Left: RIG137706. Right: RIG137707

70° HD Drop-in with 14.5-18" ......................... No Charge Length Lower Extension

Pair part: FRMASMB4853. Left: RIG137708. Right: RIG137709

6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040

6”Wx11”D1 .....................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040May cause interference on seat widths less than 18".

8”Wx11”D2 .....................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137708. Right: RIG137709.HCPCS: K0040May cause interference on seat widths less than 20".

Wheel Bumper(s) ..........................................................................................................................................$12.50 ea.Pair part: WHLASMB1578. Left part: WHL169510. Right part: WHL169511

1. Heavy Duty, Elevating Legrest Selection

2. Lower Extension

3. Reinforced Footplates(s)

4. Angle Adjustable Footplates(s) with Heel Loops

18.3. Heavy Duty, Elevating LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.

Heavy Duty, Elevating Legrest(s) with Calf Pad(s) ................................................................................................ $162.50 ea.Pair part: FRMASMB6702. Left: FRMASMB8444. Right: FRMASMB8445. HCPCS: E0990

7.25”Wx6”D Extruded Footplate ........................ StandardPart pair: FRMASMB4748. Left: RIG138055. Right: RIG138056

8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB4747. Left: RIG138060. Right: RIG138062

6”Wx8”D .......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040

6”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040

8”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040May cause interference with seat widths less than 20"

11”-14” LengthPart: FRMASMB4755. Left: RIG138026. Right: RIG138030For reinforced footplates only.

12”-14.5” LengthPart: FRMASMB4752. Left: FRMASMB5391. Right: FRMASMB4723For angle adjustable footplates only.

14”-17” LengthPart: FRMASMB4756. Left: RIG138033. Right: RIG138035For reinforced footplates only.

14.5”-18” LengthPart: FRMASMB4753. Left: FRMASMB4724. Right: FRMASMB5392For angle adjustable footplates only.

8” L(#3472)

8.5” L(#3473)

9” L(#3474)

9.5” L(#3475)

10” L(#3476)

10.5” L(#3477)

11” L(#3478)

11.5” L(#3479)

12” L(#3480)

12.5” L(#3481)

13” L(#3482)

13.5” L(#3483)

14” L(#3484)

14.5” L(#3485)

15” L(#3486)

15.5” L(#3487)

16” L(#3488)

16.5” L(#3489)

17” L(#3490)

19. SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Non-matching or individual legrest configurations lengths are not set by the manufacturer.

18. LEGRESTS continued



20. QUICK STEALTH CUSHION CONFIGURATIONOptional. Specific cushion/component sizes available, part numbers, and special order cushions can be found on the complete Stealth Cushion Order Form. This section allows a quick selection of a single cushion. The XXYY portion of the part number directly relates to the dimensions of the cushion, where XX represents the width and YY represents the depth. 20.1. Cushion Dimensions

20.2. Cushion Model Selection

20.3. Additional Fluid Proof LinersFluid Proof Urethane Liner ......................................... $50-$70Part: URL1709070-XXYY

Fluid Proof Polyurethane Liner .............................. Coming soon

20" W 22" W 24" W 26" W 28" W 16" D 18" D 20" D 22" D 24" D 26" D 28" D

Cushion DepthCushion Width

TRU-Comfort 2 SPP CushionSkin protection and positioning with 4-way stretch, breathable cover. 450 lb. weight capacity.

E2607, 20" W ......................................$400

E2608, 22"W ......................................$500

Part series: ST-TC2SPPXXYY

Simplicity G CushionGeneral use with 2-way stretch, breathable cover. 350 lb. weight capacity.

E2601, 20" W ...................................... $110E2602, 22"W to 24" W .......................... $165

Solution SPP CushionSkin protection and positioning with 4-way stretch, breath-able cover. Includes urethane liner. 350 lb weight capacity.

E2607, 20" W ...................................... $375E2608, 22"W to 24" W .......................... $430

Part series: ST-SOLSPPXXYYPart series: ST-SIMGXXYY

Spectrum Gel SPP CushionPositioning with 4-way stretch, breathable cover. Includes urethane liner. 350 lb. weight capacity. Part series: ST-SPCGSPPXXYY

E2607, 20" W ......................................$460

E2608, 22"W to 24" W .......................... $530

Spectrum Foam SPP CushionSkin protection and positioning with 4-way stretch, breathable cover. 650 lb. weight capacity.Part series: ST-SPCFSPPXXYY

E2607, 20" W ......................................$460E2608, 22"W to 24" W .......................... $530E2608, 26"W to 28" W .......................... $590

21. PROVIDER INSTALLED ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur.

Medium, Black, Weather Cover ........................................ $168Part: ACCCOVR1022

Large, Black, Weather Cover ........................................... $202Part: ACCCOVR1021

Synergy Seat Oxygen Holder ........................................... $150Not available with Synergy Manual Recline. Part: FRMASMB7030. HCPCS: E2208

Contoured Seat Oxygen Holder .........................................$118Part: FRMASMB2292. HCPCS: E2208

Contoured Seat Cup Holder...............................................$20 Non-bariatric part: ACCASMB2287. Bariatric arm part: ASSASMB2632

Synergy Seat Cup Holder ......................................... No ChargePart: ACCASMB2634

Rear Basket .................................................................$118Contoured seat part: ACCASMB1914Synergy part: FRMASMB4821

Walker Holder ............................................................. $103Synergy part: FRMASMB7031

Saddle Bag ....................................................................$35Part: DWR1020D010

Flag Holder ...................................................................$25Contoured seat part: ACCASMB1930Synergy part: ACCASMB2415

Cane/Crutch Holder .......................................................$110Contoured Seat part: ACCASMB2294. HCPCS: E2207Synergy part: FRMASMB4822. HCPCS: E2207

Stealth Large Tablet Holder ............................................ $375Part: ACC7120005

Stealth Cell Phone/Media Device Holder .............................$195Part: ACC7120006

22. BATTERIESREQUIRED. The powerchair requires 2 batteries and will be installed if ordered.

Group 24, 70 Amp Gel Cell, Interceptor Battery ............. $365 ea.Part: BAT1704614. HCPCS: E2363

No batteries. Provider will assume responsibility of batteries.Part: Configuration selection

Group 24, 70 Amp Gel Cell, MK Battery ........................ $410 ea.Part: BATGEL1009. HCPCS: E2363

https://www.pridemobility.com/pdf/order-forms/seating/us_stealth_cushions_order_form.pdf



23. BRANCH PATCHESOptional.

Air Force Army Coast Guard Marines Navy Purple Heart

Air Force Patch ...........................$20Part: ACC140240

Army Patch ................................$20Part: ACC140241

Coast Guard Patch .......................$20Part: ACC140239

Marines Patch .............................$20Part: ACC140243

Navy Patch ................................$20Part: ACC140244

Purple Heart Patch ......................$20Part: ACC140238

1. Bracket

2. Pads

3. Installation

Curved Pads, 3”x5”, pair (TWBL-3X5) ................................ $210Part: INDPART2663. HCPCS: E0956

Curved Pads, 4”x6”, pair (TWBL-4X6) ................................ $210Part: INDPART2664. HCPCS: E0956

Install LateralsPart: PTOINDV3499

Do Not InstallPart: PTOINDV3500

24.1. Stealth Thoracic LateralsSwing-away laterals may interfere with TRU-Balance 3 armrests and 2-post, flip up armrests. These laterals are not available with the back cane option.

Flip Down Bracket (TWBTLADD-HW) ................... $236.25 ea.Part: INDPART2804. HCPCS: E1028

Removable Bracket (LP430) ............................... $262.50 ea.Part: INDPART2805. HCPCS: E1028

Removable Bracket with 1” Offset .......................... $400 ea. (LP430 & LHW-121)

Part: INDPART2854. HCPCS: E1028

Flip Down with LEFT Full Surface Contact ................. $236.25 ea.Feature (TWBADD-L & LPHW407)Part: POS140428. HCPCS: E1028

Flip Down with RIGHT Full Surface Contact ................ $236.25 ea.Feature (TWBADD-R & LPHW407)Part: POS140429. HCPCS: E1028

1. Pelvic/Thigh Guide Bracket

2. Pelvic/Thigh Guide Adapter

24.2. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.

2” Height Adapter Plate (LHW-122) .................................$26.25Part: INDPART2821. HCPCS: K0108Height adapter is needed with TRU-Comfort seat cushions. Not avail-able with the flip down bracket.

2 1/4” Adapter Plate (LHW-129) .....................................$53.50Part: POS140430. HCPCS: K0108Only available with the flip down full surface bracket.

3. Pelvic/Thigh Guide Pad^Please verify the appropriate billing code to be used for this item with all third-party payors.

4. Pelvic/Thigh Guide Installation

Short Pad, 4”x4” (TWBADD-4X4) ..............................$75 ea.Part: INDPART2801. HCPCS: E0953^

Medium Pad, 4”x8” (TWBADD-4X8) ...........................$75 ea.Part: INDPART2802. HCPCS: E0953^

Long Pad, 4”x12” (TWBADD-4X12) ............................$75 ea.Part: INDPART2803. HCPCS: E0953^

Install on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586

Do Not InstallPart: PTOINDV3719

25.1. Stealth Foot Boxes^Please verify the appropriate billing code to be used for this item with all third-party payors.

Stealth Small Foot Boxes, 5"Wx8"Dx7"H ......................... $498.75(SPLE107) (pair)Part: INDPART2786. HCPCS: E0954^

Stealth Medium Foot Boxes, 6"Wx10"Dx9"H .................... $498.75(SPLE108) (pair)Part: INDPART2787. HCPCS: E0954^

Stealth Large Foot Boxes, 7"Wx12"Dx11"H ...................... $498.75(SPLE109) (pair)Part: INDPART2788. HCPCS: E0954^

25. PROVIDER INSTALLED POSITIONING COMPONENTSOptional. Not available with contoured seating. More options are available on the Positioning Components Order Form.

25.2. Stealth Padded Shoe HolderStealth Small Padded Shoe Holder 3.75"Wx6.25"D ................ $266(SPLE111) (pair)Part: INDPART2783.

Stealth Medium Padded Shoe Holder, 4"Wx8.25"D ................ $266(SPLE112) (pair)Part: INDPART2784.

Stealth X-Large Padded Shoe Holder, 5"Wx10.75"D ............... $266(SPLE114) (pair)Part: INDPART2785.

Provider installed positioning components section continued on following page.

Swing-away, Rail Mounts, pair (TWBTLTC) ......................$472.50Part: INDPART2896. HCPCS: E1028

24. MANUFACTURER INSTALLED POSITIONING COMPONENTSOptional. Not available with contoured seating. More options are available on the Positioning Components Order Form.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_positioning_components_order_form.pdf




2. Elbow Support Pad

1. Elbow Support Bracket25.3. Stealth Elbow Support

Left,Swing-Away, Elbow Support Bracket ..............$183.75 ea. Tube Style Arms (ARMS-ES-L)

Part: POS124064. HCPCS: E1028

Right, Swing-Away, Elbow Support Bracket ............$183.75 ea. Tube Style Arms (ARMS-ES-R)

Part: POS124066. HCPCS: E1028

3"Wx3"H Elbow Pad (ARMS-ES-3X3) .......................$52.50 ea.Part: POS124065. HCPCS: K0108

4"Wx4"H Elbow Pad (ARMS-ES-4X4) .......................$52.50 ea.Part: POS124067. HCPCS: K0108

25.4. Stealth i-Fit Chest Harness

25.5. Stealth i-Fit Chest Straps

Upper Classic, Medium (IFPS1103) ............... $142 ea.Part: ST-IFPS1103-Q. HCPCS: E0960

Upper Classic, Large (IFPS1104) .................. $142 ea.Part: ST-IFPS1104-Q. HCPCS: E0960

Upper Contour, Medium (IFPS2103) .............. $142 ea.Part: ST-IFPS2103-Q. HCPCS: E0960

Upper Contour, Large (IFPS2104) ................ $142 ea.Part: ST-IFPS2104-Q. HCPCS: E0960

Chest Strap, Medium w/ Belt Anchor ............. $90 ea.(IFCS4113)Part: ST-IFCS4113-Q. HCPCS: E0960

Chest Strap, Large w/ Belt Anchor ................ $90 ea.(IFCS4114)Part: ST-IFCS4114-Q. HCPCS: E0960

Contoured and ClassicChest Harness

Chest Strap

1" Ball Kit for Facial Laterals (TWB-1BK) (D) ..... $80.25Part: POS150532Required with facial laterals to mount to comfort head-rest brackets.

Egg Switch Mount (ESM) (A) ................ $52.50 ea.Part: INDPART2815

Figure 8 Bracket with 13" Rod ............ $267.50 ea. and Egg Switch Mount (B)

Part: ST-F8675-13-Q

Facial Pad, 4"x2" (900-Q)................... $53.50 ea.Part: ST-900-Q. HCPCS: K0108

Facial Pad, 6"x2" (920-Q) ................... $53.50 ea.Part: ST-920-Q. HCPCS: K0108

Swing-Away Joystick Mount, ..................$250 ea. 18" Rod (C)

Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest

Facial Lateral Pads and Accessories

25.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests. The 1" ball kit must be selected to mount the facial lateral to the headrest bracket. Also select a facial pad(s) with the facial lateral(s).

Facial Lateral for Comfort Series .............$294.25 ea.Right Side (CPS9-R-HW)Part: INDPART2647. HCPCS: E1028

Facial Lateral for Comfort Series .............$294.25 ea.Left Side (CPS9-L-HW)Part: INDPART2648. HCPCS: E1028

Facial Laterals for Comfort Series ........... $347.75 ea.Left and Right Side (CPS9-B-HW)Part: INDPART2649. HCPCS: E1028

Left and Right FacialLateral with Pads

Headrest Accessories

25. PROVIDER INSTALLED POSITIONING COMPONENTS continued

26.1. Enhanced Display

Q-Logic 3 Enhanced Display ShroudRequired with Q-Logic 3 Enhanced Display selection above. Reference colors shown on page 2.

26. SPECIALTY CONTROLSOptional. Only available with the Synergy Seating system. Select a type of specialty controls below or to refer to the specialty controls order form.

Enhanced Display

Q-Logic 3 Enhanced Display Kit .....................................................................................................$1,720Part: CTL167726Select a color option below. Includes enhanced display, flexible gooseneck and mounting bracket. Features: 3.5” LCD display; up to 5 profiles to control drive, seat, and auxiliary functions; Bluetooth connectivity for mobile devices and mouse emulation; integrated single switch scanner; IR controls.




White SatinPart: DGN137729-PWH2









Black, Soft Touch ....................................StandardPart: DGN137728

Non-matching Joystick Shroud.......................... $50Select color below

Match Joystick Shroud to Base Color .................. $50Part: See color below



EX SAJ

Q-Logic 3 EX SAJ .........................................................................................................................$700Part: CTL143980Must be used in conjunction with Enhanced Display or Q-Logic 3 Joystick.

ModuleAdult Pro-Series

Sip & Puff Module

Stealth Sip & Puff

Adult, i-Drive Tri-Array Series, 3-Switch ......... $4,414Head Array (IDHBT200-1)Part: ST-IDHBT200-1-Q. HCPCS: E2330Features bluetooth, head support, 3 non-proportional proximity sensors for drive control, an egg switch for re-set mode change, and i-Drive smart box.

Adult, i-Drive Pro Series Head Array .............. $4,461(IDHBT300-1)Part: ST-IDHBT300-1-Q. HCPCS: E2330Features bluetooth, head support with occipital pad and 2 swing-away spot pads for left and right side, 3 non-pro-portional proximity sensors, an egg switch for reset mode change, and i-Drive smart box.

Stealth Sip and Puff for Comfort Series, ............$294.25Left Mount (SP625-CL)Part: ST-SP625-CL-Q Includes straw and mounting hardware. Use with Stealth Comfort Plus headrests.

Stealth Sip and Puff for Comfort Series, ............$294.25Right Mount (SP622-CR)Part: ST-SP625-CR-QIncludes straw and mounting hardware. Use with Stealth Comfort Plus headrests.

Stealth Sip and Puff for Stealth Ultra, ............ $294.253-Switch Head Array (SP625-U)Part: ST-SP625-U-Q Includes straw and mounting hardware. Use with Stealth i-Drive Head Arrays.

Sip and Puff Module for Q-Logic 3 ..................................................................................................$1,895Part: CTL168056 Includes module and mounting hardware.

26.2. Q-Logic 3 SAJ

26.3. Head Array

26.5. Egg Switches and Switch Adapter

26.4. Sip and Puff DriveStraw and Mount

Red Egg Switch (ESRED) ..................... $80.85 ea. Part: SWTMCRO1077

Blue Egg Switch (ESBLU) .................... $80.85 ea.Part: SWTMCRO1079

Black Egg Switch (ESBLK) ................... $80.85 ea.Part: SWTMCRO1081

Green Egg Switch (ESGRN) ................. $80.85 ea.Part: SWTMCRO1078

Yellow Egg Switch (ESYEL) ................. $80.85 ea.Part: SWTMCRO1080

2 to 1 Switch Adapter ..................................$13.39Part: DWR1361H037Connects 2 single switches to a stereo jack to act as a dual switch.

27. TRU-BALANCE 3 MULTIPLIER HARNESSREQUIRED. Multiple controllers or power accessories may require an additional multiplier harness or special order. Reference the chart below to determine the appropriate selection. The rows refer to the total amount of arm mounted devices and the columns refer to the total amount of back mounted devices. The online order configurator will automatically make this selection under specialty controls.

No Additional Multiplier (NA) .................................... No ChargePart: Configuration selection

Secondary Multiplier (SM) ........................................... $221.21Part: HAR144004

Special Order Configuration (SOF)Part: Configuration selection

1 Arm 2 Arm 3+ Arm

1 Back0 Back

2 Back3+ Back

NANA No additional MultiplierSecondary MultiplierSpecial Order Required

NASM

SM

SOFSOF

SMSMSMSOF

SOFSOFSOFSOF

Q-Logic 3 Multiplier with Synergy Seat Chart

Arm

Mou

nts Joystick (Hand Control)

Enhanced DisplayiAccessUSB ChargerSAJ Ba

ck M

ount

s

Attendant ControlSCIMSip n PuffECU

Alternative Controls & Electronics Order Form Positioning Components Order Form

28. REFERENCE ORDER FORMSOptional. Select below to note that additional order forms will accompany this order form. This will also be a link in interactive forms.

©2018 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved.

Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]

facebook.com/QuantumRehab

youtube.com/QuantumRehab

instagram.com/quantum_rehab

twitter.com/quantumrehab

Egg Switch

26. SPECIALTY CONTROLS continued

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


https://www.facebook.com/QuantumRehab

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https://www.instagram.com/quantum_rehab/

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Page 1 of 7

Option Name MSRP Part Number Manufacturer Extended DescriptionELECTRONICSQ-Logic 3 EX Controller Module $695 ELE1705058 ELECTRONIC,ASSY,Q-LOGIC 3,64 HAMMER II MOTORS,Q6EDGE HD,STATIC SEATING

ELE1705059 ELECTRONIC,ASSY,Q-LOGIC 3,64 HAMMER II MOTORS,Q6EDGE HD,STATIC SEATING,W/POWER

ELE1705061 ELECTRONIC,ASSY,Q-LOGIC 3,64 HAMMER II MOTORS,Q6EDGE HD,STATIC SEATING,W/PTO

ELE1705062 ELECTRONIC,ASSY,Q-LOGIC 3,64 HAMMER II MOTORS,Q6EDGE HD,STATIC SEATING,W/POWER,W/PTO

JOYSTICK MOUNTING BRACKETSSwing-away, Inline, Left Side Mount $245 ACC142526 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,NE/NE PLUS

ACC148360 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY ,INLINE,LEFT,NE/NE PLUS,CAPTAINS SEAT

ACC142524 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,Q-LOGIC ACC148356 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,Q-LOGIC,CAPTAINS SEAT

Swing-away, Inline, Right Side Mount $245 ACC142527 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,NE/NE PLUSACC148361 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY ,INLINE,RIGHT,NE/NE PLUS,CAPTAINS SEAT

ACC142525 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,Q-LOGIC ACC148357 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,Q-LOGIC,CAPTAINS SEAT

Swing-away, 1" Offset, Left Side Mount $245 ACC142747 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,NE/NE PLUSACC148362 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,NE/NE PLUS,CAPTAINS SEAT

ACC142525 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,Q-LOGICACC148358 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,Q-LOGIC,CAPTAINS SEAT

Swing-away, 1" Offset, Right Side Mount $245 ACC142748 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,NE/NE PLUSACC148363 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,NE/NE PLUS,CAPTAINS SEAT

ACC142743 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,Q-LOGICACC148359 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,Q-LOGIC,CAPTAINS SEAT

SYNERGY BACK OPTIONS - Synergy Back SelectionSynergy Back $275 SETASMB6448 SEAT BACK,ASSY,SYNERGY STANDARD BACK,12"W,15"H,W/CUSHION,(12"W X 12"H BACK)

SETASMB6624 SEAT BACK,ASSY,SYNERGY STANDARD BACK,12"W,16"H,W/CUSHION,(12"W X 12"H BACK)

















Section NameQ6 Edge HD Cross Reference Spreadsheet - Contoured and Synergy Seating

Page 2 of 7

Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name

Q6 Edge HD Cross Reference Spreadsheet - Contoured and Synergy Seating

















SETASMB6640 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,18''D,W/CUSHION,(17"W X 14"H BACK)































Page 3 of 7

























TRU-Comfort 4-way Stretch, 20" Width or less $675 SETASMB7082 SEAT BACK,ASSY,BLACK,16"W,20"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT

SETASMB7151 SEAT BACK,ASSY,BLACK,16"W,21"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT














Page 4 of 7
























TRU-Comfort 4-way Stretch, 22" Width or greater $775 SETASMB7095 SEAT BACK,ASSY,BLACK,22"W,24"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT







Page 5 of 7




HD Sling Back $98 SETASMB5304 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,18"H,(24"W X 15"H BACK),SYNERGY SEAT SETASMB5305 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,19"H,(24"W X 15"H BACK),SYNERGY SEAT SETASMB5306 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,20"H,(24"W X 17"H BACK),SYNERGY SEAT SETASMB5307 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,21"H,(24"W X 17"H BACK),SYNERGY SEAT SETASMB5308 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,22"H,(24"W X 19"H BACK),SYNERGY SEAT SETASMB5309 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,23"H,(24"W X 19"H BACK),SYNERGY SEAT SETASMB5310 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,24"H,(24"W X 21"H BACK),SYNERGY SEAT SETASMB5311 SEAT BACK,ASSY,SLING,HEAVY DUTY,24"W,25"H,(24"W X 21"H BACK),SYNERGY SEAT SETASMB5312 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,18"H,(25"W X 15"H BACK),SYNERGY SEAT SETASMB5313 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,19"H,(25"W X 15"H BACK),SYNERGY SEAT SETASMB5314 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,20"H,(25"W X 17"H BACK),SYNERGY SEAT SETASMB5315 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,21"H,(25"W X 17"H BACK),SYNERGY SEAT SETASMB5316 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,22"H,(25"W X 19"H BACK),SYNERGY SEAT SETASMB5317 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,23"H,(25"W X 19"H BACK),SYNERGY SEAT SETASMB5318 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,24"H,(25"W X 21"H BACK),SYNERGY SEAT SETASMB5319 SEAT BACK,ASSY,SLING,HEAVY DUTY,25"W,25"H,(25"W X 21"H BACK),SYNERGY SEAT SETASMB5320 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,18"H,(26"W X 15"H BACK),SYNERGY SEAT SETASMB5321 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,19"H,(26"W X 15"H BACK),SYNERGY SEAT SETASMB5322 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,20"H,(26"W X 17"H BACK),SYNERGY SEAT SETASMB5323 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,21"H,(26"W X 17"H BACK),SYNERGY SEAT SETASMB5324 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,22"H,(26"W X 19"H BACK),SYNERGY SEAT SETASMB5325 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,23"H,(26"W X 19"H BACK),SYNERGY SEAT SETASMB5326 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,24"H,(26"W X 21"H BACK),SYNERGY SEAT SETASMB5327 SEAT BACK,ASSY,SLING,HEAVY DUTY,26"W,25"H,(26"W X 21"H BACK),SYNERGY SEAT SETASMB5328 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,18"H,(27"W X 15"H BACK),SYNERGY SEAT SETASMB5329 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,19"H,(27"W X 15"H BACK),SYNERGY SEAT SETASMB5330 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,20"H,(27"W X 17"H BACK),SYNERGY SEAT SETASMB5331 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,21"H,(27"W X 17"H BACK),SYNERGY SEAT SETASMB5332 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,22"H,(27"W X 19"H BACK),SYNERGY SEAT SETASMB5333 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,23"H,(27"W X 19"H BACK),SYNERGY SEAT SETASMB5334 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,24"H,(27"W X 21"H BACK),SYNERGY SEAT SETASMB5335 SEAT BACK,ASSY,SLING,HEAVY DUTY,27"W,25"H,(27"W X 21"H BACK),SYNERGY SEAT SETASMB5336 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,18"H,(28"W X 15"H BACK),SYNERGY SEAT SETASMB5337 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,19"H,(28"W X 15"H BACK),SYNERGY SEAT SETASMB5338 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,20"H,(28"W X 17"H BACK),SYNERGY SEAT SETASMB5339 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,21"H,(28"W X 17"H BACK),SYNERGY SEAT SETASMB5340 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,22"H,(28"W X 19"H BACK),SYNERGY SEAT SETASMB5341 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,23"H,(29''W X 19''H BACK),SYNERGY SEAT SETASMB5342 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,24"H,(28"W X 21"H BACK),SYNERGY SEAT SETASMB5343 SEAT BACK,ASSY,SLING,HEAVY DUTY,28"W,25"H,(28"W X 21"H BACK),SYNERGY SEAT SETASMB5344 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,18"H,(29''W X 15''H BACK),SYNERGY SEAT SETASMB5345 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,19"H,(29''W X 15''H BACK),SYNERGY SEAT SETASMB5346 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,20"H,(29''W X 17''H BACK),SYNERGY SEAT SETASMB5347 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,21"H,(29''W X 17''H BACK),SYNERGY SEAT SETASMB5348 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,22"H,(29''W X 19''H BACK),SYNERGY SEAT SETASMB5349 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,23"H,(29''W X 19''H BACK),SYNERGY SEAT SETASMB5350 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,24"H,(29''W X 21''H BACK),SYNERGY SEAT SETASMB5351 SEAT BACK,ASSY,SLING,HEAVY DUTY,29''W,25"H,(29''W X 21''H BACK),SYNERGY SEAT SETASMB5352 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,18"H,(30''W X 15''H BACK),SYNERGY SEAT SETASMB5353 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,19"H,(30''W X 15''H BACK),SYNERGY SEAT SETASMB5354 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,20"H,(30''W X 17''H BACK),SYNERGY SEAT

Page 6 of 7



SETASMB5355 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,21"H,(30''W X 17''H BACK),SYNERGY SEAT SETASMB5356 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,22"H,(30''W X 19''H BACK),SYNERGY SEAT SETASMB5357 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,23"H,(30''W X 19''H BACK),SYNERGY SEAT SETASMB5358 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,24"H,(30''W X 21''H BACK),SYNERGY SEAT SETASMB5359 SEAT BACK,ASSY,SLING,HEAVY DUTY,30''W,25"H,(30''W X 21''H BACK),SYNERGY SEAT SETASMB5360 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,18"H,(31''W X 15''H BACK),SYNERGY SEAT SETASMB5361 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,19"H,(31''W X 15''H BACK),SYNERGY SEAT SETASMB5362 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,20"H,(31''W X 17''H BACK),SYNERGY SEAT SETASMB5363 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,21"H,(31''W X 17''H BACK),SYNERGY SEAT SETASMB5364 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,22"H,(31''W X 19''H BACK),SYNERGY SEAT SETASMB5365 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,23"H,(31''W X 19''H BACK),SYNERGY SEAT SETASMB5366 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,24"H,(30''W X 21''H BACK),SYNERGY SEAT SETASMB5367 SEAT BACK,ASSY,SLING,HEAVY DUTY,31''W,25"H,(31''W X 21''H BACK),SYNERGY SEAT SETASMB5368 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,18"H,(32''W X 15''H BACK),SYNERGY SEAT SETASMB5369 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,19"H,(32''W X 15''H BACK),SYNERGY SEAT SETASMB5370 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,20"H,(32''W X 17''H BACK),SYNERGY SEAT SETASMB5371 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,21"H,(32''W X 17''H BACK),SYNERGY SEAT SETASMB5372 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,22"H,(32''W X 19''H BACK),SYNERGY SEAT SETASMB5373 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,23"H,(32''W X 19''H BACK),SYNERGY SEAT SETASMB5374 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,24"H,(32''W X 21''H BACK),SYNERGY SEAT SETASMB5375 SEAT BACK,ASSY,SLING,HEAVY DUTY,32''W,25"H,(32''W X 21''H BACK),SYNERGY SEAT

SYNERGY BACK OPTIONS - Synergy Back Cane Height14" High Canes Standard FRMASMB15832 BACK CANE,ASSY,W/SHORT PUSH HANDLE,14"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17097 BACK CANE,ASSY,W/SHORT PUSH HANDLE,14"H,SLING,SYNERGY,TEXTURED15" High Canes Standard FRMASMB15833 BACK CANE,ASSY,W/SHORT PUSH HANDLE,15"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17098 BACK CANE,ASSY,W/SHORT PUSH HANDLE,15"H,SLING,SYNERGY,TEXTURED16" High Canes Standard FRMASMB15834 BACK CANE,ASSY,W/SHORT PUSH HANDLE,16"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17099 BACK CANE,ASSY,W/SHORT PUSH HANDLE,16"H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15774 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,16"H,6 HOLE,SYNERGY,TEXTURED

17" High Canes Standard FRMASMB15835 BACK CANE,ASSY,W/SHORT PUSH HANDLE,17''H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17100 BACK CANE,ASSY,W/SHORT PUSH HANDLE,17''H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15775 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,17''H,6 HOLE,SYNERGY,TEXTURED18" High Canes Standard FRMASMB15836 BACK CANE,ASSY,W/SHORT PUSH HANDLE,18"H,6 HOLE,SYNERGY,TEXTURED


19" High Canes Standard FRMASMB15837 BACK CANE,ASSY,W/SHORT PUSH HANDLE,19"H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17102 BACK CANE,ASSY,W/SHORT PUSH HANDLE,19"H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15777 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,19"H,6 HOLE,SYNERGY,TEXTURED20" High Canes Standard FRMASMB15838 BACK CANE,ASSY,W/SHORT PUSH HANDLE,20"H,6 HOLE,SYNERGY,TEXTURED



$62.50 x 2qty FRMASMB15779 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,21''H,6 HOLE,SYNERGY,TEXTURED22" High Canes Standard FRMASMB15840 BACK CANE,ASSY,W/SHORT PUSH HANDLE,22''H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17105 BACK CANE,ASSY,W/SHORT PUSH HANDLE,22''H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15780 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,22''H,6 HOLE,SYNERGY,TEXTURED

23" High Canes Standard FRMASMB15841 BACK CANE,ASSY,W/SHORT PUSH HANDLE,23"H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17106 BACK CANE,ASSY,W/SHORT PUSH HANDLE,23"H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15781 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,23"H,6 HOLE,SYNERGY,TEXTURED24" High Canes Standard FRMASMB15842 BACK CANE,ASSY,W/SHORT PUSH HANDLE,24"H,6 HOLE,SYNERGY,TEXTURED


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$62.50 x 2qty FRMASMB15783 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,25''H,6 HOLE,SYNERGY,TEXTURED

Documents

Quantum Q6 Edge HD Light Rehab Seating Order Form · Deep Purple Lime Light Grey Street Midnight Blue Orange Crush Yellow Blaze Rim Color Optional. Rim colors other than the standard