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Serial Number: ________________________
Manufacturing Date: _______/20_____
RGK Head Office: Units 8 A/C Ring Road, Zone 2, Burntwood Business Park, Burntwood, Staffordshire, WS7 3JQ, UKTelephone:+44 (0) 1543 670077 - Fax:+44(0)1543 670088 - [email protected] - www.rgkwheelchairs.com
To place order: [email protected]
To request quotation: [email protected]
Distributor Name: Notes/Comments:
Contact Name:
Purchase Order No:
Delivery Address:
Contact Name:
Telephone:
Email:
A/C No: Net Value: $
Who Date Freight: $
OK to Quote: Invoice Value: $
OK to Confirm: Payment Received: $
Document No: DOC
FOR RGK OFFICE USE ONLY
Postcode:
Page 1 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
Base product Mandatory information Information required for option
Standard configuration Option with no extra cost Option with extra cost
TGAXZ011
XA070
XA080
TGAXA085 Crash tested upgrade
Max User Weight 125kg
XW010 Full CAD drawing for approval
XA070 - Open design XA080 - Closed design
XW011 Quick CAD drawing for approval
(Basic outline of chair within 2 working days*) *Approximate time only
XY010
XY020
XY030 Extra seat length (Provides additional leg support & hand grip)
XY050
XY060
XY070
(Min = XY020 + XY030 + 140mm)
XY072
Optimise measurements
XA020 Ergonomic seat
Specify length
(Standard = 120mm)
Closed design
Open design
$144
mm(Max - 550mm)
(Min - 380mm)
Rear frame height
TIGA
Front frame height
Seat length
mm(Max - 500mm)
mm
KEY FRAME MEASUREMENTS
mm(Max - 500mm)
Seat width (Inside to inside of sideguards)
mm
mm
Castor position
mm
(Max - 550mm)
(Min - 360mm)
Frame length
mm
$3,758
$65
$135
$88
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Page 2 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XY080 XY091
Specify width Specify width
XY100 XY105
XB200 XB200
XY115
XY120
(Std = 20 lower than front height)
XY125
(Std = 100mm)
XB010 XB030
(Height adjustable)
XB070 XB150
(Angle/height adjustable) (Height adjustable)
(No height adjustment)
XB050 XB170
XB040 XB165
125mm 175mm
Max
Height
With
XB200
3" 185mm
(When combined with
XY080 , dimensions must be
smaller by 20mm)
Footrest Design (Choose One)
(When combined with
XY091 , dimension is
inbetween the centre of the
main bends)
Round design Square design
Castor
Size
3" 135mm
Castor
Size
Max
Height
115mm
With
XB200
165mm
FRONT FRAME AND FOOTRESTFront Frame Options
Parallel taper design
mm mm
Seat taper design
Heavy duty tubular footrestAngle adjustable aluminium footrest
$103
(3M Safety walk)(not with XB030)Plastic Cover
Carbon fibre cover Aluminium cover
Rubber grip tape
(Not with XB070 & XB030)
(Not with XB070 & XB030)
(Not with XB070 & XB030)
$30$56
TGAXB080
$91
$108
mm
mm
Footrest Style (Choose One)
$218
Footrest length
Tubular aluminium footrest Flip up plastic footrest
(Angle/height adjustable) (with closed frame only)
$114
185mm
High level footrest (Only with XB010, XB080 &
XB150)
High level footrest (Only with XB010, XB080 &
XB150)
5"135mm
$56
Tubular footrest welded into frame
Footrest Cover
$114
4"
5"
145mm 195mm4"
Footrest Individual Measurements
Rear footrest height
mm
155mm 205mm
Front footrest height
$114
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Page 3 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
CASTOR WHEELS, FORKS & WHEEL LOCKSCastor Wheels
XC150
XC060
XC110
XC137
XC130
Silver hub & red tyre
XB
XC070 XC120 Froglegs Aluminium centre 5"x1"
(Silver hub and black urethane tyre)
XC100 XC140 Froglegs Aluminium centre 5"x1.4"
(Silver hub and black urethane tyre)
XC145
(Silver hub and black urethane tyre)
XC190 XC210
Note: Colour follows accent Black Silver
XY330 Castor pin width
XD020 XD050
XD030 XD046
XD035 XD010
XD045
Optimise measurements(Minimum width for clear castor rotation and
maximum wheelbase length)
Castor Pin Width
mm
Castor Forks
Low ride castor fork Froglegs suspension castor fork
$376
6"
Frog Legs aluminium centre 6"x1.4"
$103
Wheel Lock Options (choose one)
Ch
oo
se o
ne
ca
s to
r o
pti
on
on
l y
3"
$103
4"
$103
$103
Purple hub & black tyreBlack hub & blue tyre
Black hub & red tyre
Silver hub & black tyre (Std)
Blue hub & black tyre Green hub & black tyre
Black hub & black tyre
$96
$81
Omit wheel locks
$140
Push to lock
Compact scissor with lightweight fixing
Compact scissor
Underseat Scissor
(Only with fixed centre of gravity)
Out Front Compact scissor
Out Front push to lock
$140
$148
Silver hub & blue tyre
Gold hub & black tyre
(Black hub & black urethene tyre)
Froglegs Aluminium centre 4"x1.4"
(choose colour below)
Red hub & black tyre
5"
$116
Soft roll 5"x1.3"
(Black)
Pneumatic Aluminium centre 5"x1"
(Grey)
$103
$103
(Std when no option selected)
Froglegs Aluminium centre 3"x1.4"
(Silver hub and black urethane tyre)
Froglegs Aluminium centre 4"x1" (Silver hub and black urethane tyre)
Froglegs Carbon composite centre 4"x1.25"
(Black)
Soft roll 4"x1.3"
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Page 4 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XE030 XE040 Screw on aluminium with fender
XE080 XE090 Lift out aluminium with fender
TGAXE130 TGAXE140 Fold flat aluminium with fender
XE180 XE190 Flip back aluminium with fender
TGAXE220
TGAXE230
(Extra strong) XE060 Screw on carbon fibre with fender
XE110 Lift out carbon fibre with fender
XE050
TGAXE160 Fold flat carbon fibre with fender
XE100
XE210
TGAXE150
XE200
XE070
XE120
TGAXE170
XF010
XF020
Optimised measurements Outside of tyre
Fold flat aluminium
$144
$330
Lift out aluminium
$358
$171
Screw on aluminium
SIDEGUARDS AND ARMRESTSSideguard Sideguard with Fender
Aluminium Options Aluminium Options
$521
$314
Lift out carbon fibre
Welded aluminium sport
$171 $199
Flip back aluminium
Welded with 6mm bead
$305
$421Carbon Fibre Options
$218 Carbon Fibre Options
$564
$321
$286
Flip back carbon fibre with fender
Fold flat carbon fibre $421
Flip back carbon fibre Sideguard Measurements
Screw on carbon fibre
$347
mm
Armrest Options
$368
mm
Sideguard Measurements
Ch
oo
se o
pti
mis
ed
or
ind
ivid
ua
l me
asu
rem
en
ts
mm
Individual measurements
Sideguard length
Sideguard height
$144
$214
$447
$464
Individual above tyre
(Follow tyre)
Level with tyre
(Follow tyre)
Lift out armrest with plastic sideguard
(Indicate fixed height)
Lift out armrest with Aluminium sideguard
(Indicate fixed height)
25mm above tyre
mm
Height (Top of seatrail to top of armrest)
$368
Centre of tyre
(Standard if no option selected)
Fender Height
Fender position
(Follow tyre)
mm
10mm above tyre (Standard)
Individual above tyre
(Min = 10mm)
ABS Plastic Options
Screw on ABS plastic
Lift out ABS plastic
Fold flat ABS plastic
$286 �
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Page 5 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XY230 XY245
Specify height
XG010
XY360 XG100
-5 -3 0 +3
Individual
XG110 XG120
XG070 XG090
XG080
XG085
Optimise
XG040 XG130
XG140 Integrated lateral support
A - Left A - Right
B - Left B - Right
C - Left C - Right
D - Left D - Right
$65 $65
Ergonomics - Rearward Positioning
Backrest angle Ergonomic backrest
$65
(Max -10/+20 Deg)
Ergonomics - Lateral Positioning (Choose One)
mm
+5
mm
Rearward position
Deg
Vertical height
Inward taper Outward flare
mm
Backrest Design - Fixed or Folding (Choose One)
Fixed backrest (Non-folding) Folding backrest with 2 position snap lock
and angle adjust ( ± 5 Deg)$270
Specify height
mm
TGAXG020
(+/-25mm)
BACKRESTBackrest Height - Fixed or Adjustable (Choose One)
Fixed height backrest
$108
Adjustable height backrest
Screw in push handles
Flip down push handles
(N/A with XY245)
(N/A with XY245)
Stroller push handles height adjustable
Height from floor to top of handles
ILSA Backrest Options
$339
mm
Extra deep brace bar
$116 $65
Depth
Heavy duty backrest upgrade (Recommended for hand cycling) (Not with XY245) (Recommended for JAY backs) (Std - 90mm)
mm
mm
mm
mm
mm
mm
mm
mm
Specify width or per side
(inside of backrest posts) (inside of backrest posts)
Backrest Options
(1000mm from floor)
$214
Flip down push handles height adjustable
(N/A with XY245)
Specify width or per side
mm
Push handle Options
mm
$194
$224$127
mm
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Page 6 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XH110 TGAXH100
(25-150mm)
(Not with Crash test option)
Specify measurement Specify measurement
XH120 TGAXH090
(60-150mm)
Specify measurement Specify measurement
#
XY390 XY390
0 1 2 3 5 0 1 2 3 5
XH030 XH040
XH040
0 5
0 5
XJ010 XJ100
XJ020
CAMBER BAR
$270
Square back adjustable
centre of gravity
Adjustable Centre of Gravity Fixed Centre of Gravity
Single post fixed centre of
gravity
(25-125mm)
mm mm
Specify Camber Angle Specify Camber Angle
(25-125mm)
(Open frame only)
mm mm
$270
Round back adjustable
centre of gravity
V-style fixed centre of
gravity
Camber angle Camber angle
Froglegs suspension camber bar Handbike camber bar fixed
Handbike camber bar fixed
$116
Single sport anti tip
(centre mounted)
Anti-Tip Options
Swingaway anti tip LEFT side (Only with square
back frame. Not with XH040)$116 $358
Swingaway anti tip RIGHT side (Only with square
back frame. Not with XH040)
Castor height from floor for handbike
fitting
30 50
(Standard 30mm if not indicated)
30 50
(Standard 30mm if not indicated)
Camber Bar Options Camber Bar Options
$544 $227
Camber angle (Handbike camber bar)
$227
Camber angle (Handbike camber bar)Castor height from floor for
handbike fitting�
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Page 7 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XY420
XY460
Individual
TGAXA085
XK010 XK320
XK050 XK060
XK150 XK070
Spinergy Colour Options:
XK180 Custom spoke design
(Specify colour)
Inside:
Outside:
Custom Anodise Options
XK190 XK200 XK201
(LX, XLX & BLXL only)
XK202 XK203 XK204
(LX, XLX & BLXL only) (LX, XLX & BLXL only) Select colour:
XY480 XY485
XL090
XL010 XL040
XL030 XL050
XL020 XL140
XL100
XM010 Red
XM130
XM020 XM060
XM040 XM050(Black) (24",25" only)
XY500 XY490
XK220 XK300
XK240 XK310
$140 $140 $184
Fusion 16 spoke
$597
Spinergy LX 12 spoke
$427
$133
Purple / Black hub
Black hub Silver hub Red hub/rims
Spinergy BLXL 18 blade spoke
(Silver Hub, black spokes)
Red / Black hub Blue / Black hub
$70 $70 $140
Purple hub/rims Blue hub/rims Custom hub/rims
REAR WHEELS
Wheel Options (Choose one)
Wheel Gap
Rear wheel gap
15 20 25
mm
Wheel Size
26" Wheels24" Wheels XY430 25" Wheels XY440
Wheel Accessories
$127
$526$92
Titanium 130mm quick release axle pins (pair)
(N/A with XK010 & XK070)
Quad release axle nuts (pair)
$526
Offroad wheel set 22" rim with handrim, MTB tyre
and axle pins (Replaces 24" wheel with XM010)
Offroad wheel set 24" rim with handrim, MTB tyre
and axle pins (Replaces 25" wheel with XM010)
Schraeder inner tube valve Presta inner tube valve
Inner Tube Valve Options
$22
(Standard if no option selected)
$15
$56 $77
Shox solid airless Kenda K885 mountain bike tyre (24",25"
only)$91
$276 $108
Tyre Options
Ergo gripp 6 tab wide
$241
$231
$231
Para grip 6 tab
Tetra grip 6 tab
$196
Kenda
Schwalbe Marathon Plus Schwalbe One (24",25" only)
BlueGrey (std)
Kenda black
Surge LT 6 tab Stainless steel 6 tab
Aluminium hard anodised 6 tab Titanium 6 tab
Remove excess mounting tabs
(recommended for small wheel gaps)
Spinergy XLX 12 spoke, cross/radial spoked
Spinergy SPOX 18 spoke
Spinergy CLX 18 carbon blade spoke
Pink / Black hub Orange / Black hub
Handrim Position / Options
$567
Narrow set handrim Wide set handrim
Handrim Styles
$83
$597$1,128
Yellow / Black hub Green / Black hub
Black / Silver hub White / Black hub
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Page 8 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XN010 XN150
Frame Comp. Frame Comp. Frame Comp.
XN200
Frame Comp.
XN160
TGAXN050 XN170
(Castor caps only, black for rest)
XP040 XR050
XP050
XP060 XP070
XP110 XP170
Silver Black Blue
$73 $111 (Please provide .jpeg file and positioning)
(Standard if not indicated)
Red Light blue Purple
Backrest Accessories
Backrest with zip pocket Individual backrest embroidery
Red Black (std) Red
Backrest Upholstery Stitching Options
Polished components
Note: Accent colour includes, forks & castor caps.
Backrest Upholstery Logo Options
Airtech backrest strap adjustable
Backrest upgrade to full leather Backrest upgrade to leather corners
$282 (select colour) $98 (not with flip down push handles) (select colour)
Silver Black Blue
(Standard if not indicated)
Red Light blue Purple
Black (std)
TGAXN030 Brushed frame Brushed components
Backrest Upholstery
Black accent Silver accent
Red accent Blue accent
Purple accent Carbon accent
UPHOLSTERYSeat Upholstery
Seat sling adjustable tension with straps Carbon fibre seat plate
$275
Accent Colour (Choose One)
$78
Polished frame
$133
$195
$500
Orange gloss 180
Purple gloss 157
Green gloss 107 Custom
Dark blue gloss 151 Custom paint colour
Royal blue gloss 154 $140
Blue gloss 174 Select colour/RAL:
Duckegg blue gloss 141
Pink gloss 188
Forest green gloss 143 White sandpaper 200
Grey gloss 132 Grey matt 131 Metallic black matt 104
Cream gloss 135 Light grey matt 133 Metallic grey matt 130
Red gloss 108 Navy blue matt 152 Black sandpaper 201
Yellow gloss 120 Grey sandpaper 202
Black gloss 103 Black matt 105 Chrome Mirror 300
White gloss 100 White matt 101 Sparkle silver 170
FINISH OPTIONSFrame & Component Finish
Powder coated frame
Gloss Matt Special
Powder coated components
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Page 9 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
XP080 Cushion foam with nylon cover
(select density and size below)
#
XP090 Air Lite cushion cover
(Black)
XP100 Leather cushion cover
(select colour below)
XP250 Select size
(Price subject to change dependant on size)
XP251 Select size
(Price subject to change dependant on size)
Other Jay cushion, please specify code, cost, size and description:
XR060
Specify height from floor
XR080
XP120
XR010 Seat pouch velcro attach (Black)
XR190 Phoenix Unstoppable gear bag
XR200 Rucksack with RGK logo (Black)
XR020 Underseat large storage bag (Black)
XA020
XS060
Optimise measurements
FRAME OPTIONS
Welded calf strap mounting loops
$83 (To locate calf strap on front frame)
100mm
Cushion cover options
Jay Cushion
Black (std) Red Grey
$197
50mm 75mm
$53
$173
$531
JAY Extreme Active fluid pad
JAY Easy Visco
CUSHION
$68
Soft (CMS040) Medium (CMS050) Hard (9lb recon)
Cushion foam options
Tool kit
Calf strap
ACCESSORIES
Frame protectors neoprene zip fasten with TIGA logo (Nylon
with velcro fasten with XR060)$59
$31
$73
$435
$52
(Office use only)
$594
Frontwheel assembly
(Only with XB010, TGAXB080, XB150)
Frontwheel serial
number:
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Page 10 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
NOTES
Page 11 2020_V1
Serial Number: _______________________
Manufacturing Date: _______/20_____
Who are we?
What personal data do we collect?
Why do we collect this personal data?
What do we do with your information?
Your information is stored in our order processing system which is based within the European Union.
How long do we keep your personal data for?
Your financial data will be stored for seven years as is required by UK Law.
Your rights over your personal data
You can also ask us to stop using your data if you believe we are not processing it lawfully.
To submit a request by email, post or telephone, please use the contact information provided in the ‘Who are we?’ section.
Your right to complain
Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Data Privacy - Customer Order Forms
This data privacy notice tells you about the personal data we collect from you when you purchase one or more of our
products. In collecting this personal data, we are acting as a data controller and, by law, we are required to provide you with
information about us, about why and how we use your data, and about the rights you have over your data.
We are RGK Wheelchairs. Our address is Units 8a/b/c Ring Road, Zone 2, Burntwood Business Park ,Burntwood, Staffordshire,
WS7 3JQ UK
You can contact us by post at the above address, by email at [email protected] or by telephone on +44 (0)1543
670077 - Any enquiries about our use of your personal data should use the contact details above.
When you purchase products from us, we ask you for your name, address, contact telephone number, email address. Where
necessary some personal details such, as; height, weight, limb measurements and any disability or disease will be required. To
fulfil your order (unless under contract) we will also need your bank account details.
If you have a complaint about our use of your information, you can contact the Information Commissioner’s Office via their
website at www.ico.org/concerns or write to them at:
We will use your personal data to allow the configuration and/or customisation of your purchase, process your order and to
send you your goods. We will also send you an invoice and a delivery note. If we have a question about your delivery we will
use your telephone number or email address to contact you.
We process special personal data (Health) for the purposes of the provision of healthcare treatment and manufacturing of
your product. The Lawful basis for processing normal personal data is Legitimate Interest this enables us to complete your
order, process your payment, deliver your goods and fulfil our contract with you.
We use a third-party courier companies to deliver your goods and we share with them your name, address and telephone
number in order to complete the delivery.
We do not use the personal data you provide to make any automated decisions that might affect you. Your data will be
shared with an external dealer (if required) and internally with our Sales Team, Customer Services, Financial Services and
Quality/Warranty departments to enable fulfilment of your order and provide support services.
Your non-financial data will be stored for the period of the warranty of the particular product purchased for a maximum of
five years.
By law, you can ask us what personal data we hold about you. You can request a copy, correct it if it is inaccurate, request we
erase it, and transfer a copy to another data controller.
Page 12 2020_V1
