Invacare REA Dahlia 45 Transit Dealer Max User Weight 135Kg (21 stone)

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1 Invacare Ltd Manual Prescription Form Pencoed Technology Park Dealer Prescription Form Pencoed CF35 5AQ LPF1U2READAHLIA140515Dealer Tel: +44 (0) Fax: +44 (0) July For up to date spare parts online, please visit Customer Name : Account No : Address : Order Qty : Tel Number : Delivery Address : Order Date : Invacare REA Dahlia 45 Transit Dealer Max User Weight 135Kg (21 stone) Standard Features: Transit Propulsion 16" Solid Tyre with Attendant Hub Brakes Choice of Seat Widths 390mm to 490mm (+50mm and +100mm) Choice of 4 Seat Heights 350mm - 500mm (14" - 20") Depth Adjustable Seat 430mm-500mm (17" - 20") Flex 3 Backrest Plate, Passad 2 Cushion with Connected Push Handles Assistant Operated Gas Piston Seat and Backrest Recline with Tilt Lock 80 Fixed Legrests Swing In Swing Out Height Adjustable Standard Armrests (including autolock) Sideways Adjustable Neckrest Black Frame User Manoeuvred Tyre Brakes Solid Tyres Pelvic Belt, Transportation Brackets, Anti Tippers Standard Base Price : 2,026 please make your selection with a cross in the box Standard feature Free of Charge (NC9999) non conformance with option 9999 Customer weight = Kg Code Description NC's (Non Conformance) Dealer BXA0015 X Rea Dahlia 45 2,026 BXA8000 Rea Dahlia 45 Special Basic Model - PLEASE COMPLETE DETAILS AT THE END OF THE FORM POA PROPULSION TYPE BXA0020 Equipped with 16" transit wheels inc. hub brakes SEAT DIMENSIONS SEAT WIDTH BXA mm (15") ( Small chassis) BXA mm (17") ( Medium chassis) BXA mm (19") ( Large chassis) (NC: 0330) SEAT WIDTH ADJUSTMENT (PRE ADJUSTMENT) BXA mm seat width pre adjustment BXA mm seat width pre adjustment BXA0100 No seat width extension (NC: 0420; 0430) SEAT DEPTH ADJUSTABLE BXA0110 X mm (17" - 20") Due to how highly configurable the REA Dahlia is please refer to the following guide to help highlight the combination of options that are available. Page 1 of 6

2 SEAT HEIGHT BXA mm (14") available with 16" rear wheels (NC: 1400; 1410; 1420; 1430; 1440; 1450; 1470) BXA mm (15") available with 16" rear wheels (NC: 1390; 1410; 1420; 1430; 1440; 1450; 1470) BXA mm (19") available with 16" rear wheels (NC: 1390; 1400) BXA mm (20") available with 16" rear wheels (NC: 1390; 1400; 1410; 1420; 1430) SEAT TILT ANGLE BXA0200 X Positive Seat angle 45º BACKREST RECLINE ANGLE BXA0207 X Backrest recline 30º SEAT CUSHION BXA0230 Cushion Floshape 45 BXA0280 Without seat cushion SEAT UPHOLSTERY BXA0290 Black plush TR35 BXA0300 Black dartex TR26 BACKREST TUBES BXA angled tubes, bent 380mm above seatplate (to fit Matrx backrests) (NC: 0390; 0400; 0550; 0560) BXA0320 Straight tubes (to fit Flex 3 and Matrx) BACKREST RECLINE PIVOT JOINT BXA mm width extension 67 BXA0340 Without width extension FLEX 3 BACKREST BACKREST TYPE BXA0390 Backrest plate - Flex 3 width and height adjustable (NC : 0450) BXA0400 Tension adjustable - Flex 3 width and height adjustable (NC : 0420; 0430; 1250) 80 BXA0410 Backrest tubes without backrest (NC: 0420; 0430; 0450; 0460; 0470; 0480; 0490; 0520; 0530; 1040; 1050; 1060; 1070; 1080; 1090; 1100; 1110; 1120; 1130; 1200; 1210; 1220; 1230; 1240; 1250) FLEX 3 BACKREST WIDTH ADJUSTMENT (PRE ADJUSTMENT) BXA mm width pre adjustment If selecting this option on the Tension adjustable backrest, the +50mm seat width adjustment must also be selected BXA mm width pre adjustment BXA0440 Without width pre adjustment BACKREST COVER/ CUSHION BXA0450 Cover, Lateral for tension adjustable upholstery BXA0460 Cushion, Laguna (lateral support) BXA0470 Cushion, Mistral 2 (waist support) 113 BXA0480 Cushion, Passad 2 (shoulder support) BXA0490 Cushion, Shoulder High 05 (dartex) (NC: 0520) 118 BACKREST UPHOLSTERY BXA0520 Black plush TR35 BXA0530 Black dartex TR26 HEIGHT ADJUSTABLE PUSH HANDLES BXA0540 Push bar, angle adjustable 80 BXA0550 Push handles divided BXA0560 Push handles connected SEATING SEAT TILT TYPE BXA0580 Assistant hand operated gas piston seat tilt BACKREST RECLINE REGULATION TYPE BXA0600 Assistant operated gas piston for backrest recline LEGRESTS / FOOTRESTS CENTRAL LEGRESTS TYPE Central legrest, incl calfpad and footrest. Not to combine with separate BXA0630 footrest lower parts, abduction cushion, footplate extender and clinic kit. LEGREST/HANGER POSITION (NC : 0650; 0660; 0670; 0680; 0690; 0710; 0720; 0730; 0740; 0760; 0770; 0790; 0810; 0830; 0850; 1010; 1270; 1280; 1300; 1310; 1800) BXA0640 Low position, standard BXA0650 High position, mounted 50mm higher LEGRESTS / HANGERS LH TYPE BXA0660 Hanger angle adjustable - alu 2008 LH. With knee pad and calf support 78 BXA0670 Hanger fixed 80º, swing in swing out - alu 2003, LH BXA0680 Hanger fixed 90º, swing in swing out - alu 2003, LH (NC : 0810; 1270; 1310; 1390; 1440; 1450; 1470) BXA0690 Legrest amputee - alu 2008 LH (NC : 0760; 0770; 0790; 0810; 1270; 1280; 1290; 1300; 1310) Page 2 of 6

3 LEGRESTS / HANGERS RH TYPE BXA0710 Hanger angle adjustable - alu 2008 RH. With knee pad and calf support 78 BXA0720 Hanger fixed 80º, swing in swing out - alu 2003, RH BXA0730 Hanger fixed 90º, swing in swing out - alu 2003, RH (NC : 0850; 1270; 1310; 1390; 1440; 1450; 1470) BXA0740 Legrest amputee - alu 2008 RH (NC : 0760; 0770; 0830; 0850; 1270; 1280; 1290; 1300; 1310) 108 FOOTRESTS ONE PIECE BXA0760 Footrest one piece depth and angle adjustable short tube (NC : 0790; 0810; 0830; 0850) 93 BXA0770 Footrest one piece depth and angle adjustable long tube (NC : 0790; 0810; 0830; 0850) 93 FOOTRESTS LH TYPE BXA0790 Footrest lower part, depth and angle adjustable with short tube and heel strap, LH BXA0810 Footrest lower part, depth and angle adjustable with long tube and heel strap, LH FOOTRESTS RH TYPE BXA0830 Footrest lower part, depth and angle adjustable with short tube and heel strap, RH BXA0850 Footrest lower part, depth and angle adjustable with long tube and heel strap, RH ARMRESTS ARMRESTS LH TYPE BXA0870 Height adjustable, Dartex padded ducktail pad, LH (Autolock armrest included) BXA0880 Height adjustable wide pad, LH Only combine with 16" rear wheels (Autolock armrest included) BXA0890 Hemiplegic armrests, LH. Not possible to combine with standard table. (Autolock armrest included) ARMRESTS RH TYPE BXA0930 Height adjustable, Dartex padded ducktail pad, RH (Autolock armrest included) BXA0940 Height adjustable wide pad, RH Only combine with 16" rear wheels (Autolock armrest included) BXA0950 Hemiplegic armrests, RH. Not possible to combine with standard table. (Autolock armrest included) SEATING OPTIONS (NC : 0980; 1710; 1720; 1730; 1740; 1750) 141 (NC : 0980; 1710; 1720; 1730; 1740; 1750) 141 ARMREST OPTIONS BXA0980 Pad for siderest, removable with velcro 40 SEAT OPTIONS BXA0990 Incontinence cover 31 BXA1000 Abduction/Pommel cushion (NC : 1020) 93 BXA1010 Seat plate extension plates, 2 pieces. Width, forward, rear or assymetric 33 BXA mm increased seat height plate 50 BXA1030 Scale for seat tilt 35 BACKREST OPTIONS BXA1040 Headrest, sideways adjustable (NC : 1060; 1070; 1072; 1080) BXA1050 Cover for headrest (NC : 1060; 1070; 1072; 1080) 25 BXA1060 Headrest with cheek support, sideways adjustable (NC : 1070; 1072; 1080) 85 BXA1070 Neckrest BXA1080 Cover for neckrest 16 BXA1085 3rd Party headrest bracket 15 BXA1090 Handles clinic kit for head/neckrest 38 BXA1100 Trunk support multi adjustable with standard arm (LH) (NC : 1220) BXA1110 Trunk support multi adjustable with standard arm (RH) (NC : 1220) BXA1120 Trunk support multi adjustable with extended arm in height (LH) (NC : 1220) BXA1130 Trunk support multi adjustable with extended arm in height (RH) (NC : 1220) BXA1200 Trunk support multi adjustable swingaway (LH) (NC : 1220) 89 BXA1210 Trunk support multi adjustable swingaway (RH) (NC : 1220) 89 BXA1220 Trunk support attachment BXA1230 Lumbar support cushion 24 BXA1240 Wedges (one pair) 8 BXA1250 Privacy attachment (material connecting backrest and seat) 26 BXA1260 Scale for backrest recline 35 LEGREST OPTIONS BXA1270 Footplate extender LH (NC : 1300) 26 BXA1280 Footplate extender RH (NC : 1300) 26 BXA1290 Heel strap (for one piece footrest) BXA1300 Pad for footrest 42 BXA1310 Calf strap padded 57 Page 3 of 6

4 CASTOR ATTACHMENT TYPE BXA1370 Fixed FRONT CASTORS BXA mm x 27mm (4" x 1") medium hard BXA mm x 27mm (5" x 1") medium hard BXA mm x 37mm (5.5" x 1.5") soft 15 BXA mm x 27mm (6" x 1") medium hard 15 BXA mm x 30mm (6" x 1.25") soft BXA mm x 27mm (8" x 1") medium hard BXA mm x 30mm (8" x 1.25") soft BXA mm x 45mm (8" x 1.75") medium hard REAR WHEEL ATTACHMENT TYPE BXA1490 Fixed REAR WHEEL TYPE/SIZE BXA " Transit TYRE TYPE BXA1560 Pneumatic block pattern tyre BXA1580 Solid PU tyre SAFETY BRAKE TYPE BXA1680 X User manoeuvred tyre brakes SAFETY OPTIONS BXA1690 X Pelvic belt BXA1700 Reflectors kit (wheels and chassis) 16 ACCESSORIES BXA1710 Table tray incl mounting kit (NC : 1750) 109 BXA1720 Table tray cushion (NC : 1730; 1750) 40 BXA1730 Swing away table (NC : 1740; 1750) 153 BXA1740 Locking device for table tray (NC : 1750) 11 BXA1750 Mounting kit for table (if ordered separately) 6 BXA1780 Pump 16 BXA1790 Cane holder 39 BXA1800 Clinic kit 43 BXA1810 Harness attachment bracket (pair) on seat 17 BXA1820 Harness attachment bracket (pair) upper 17 BXA1830 Tipping lever (NC : 1860) 33 BXA1850 X Transportation brackets BXA1860 Accessories tray (to suit Ventilators etc. Positioned at the rear of frame between rear wheels) 208 SPECIALS BXA8010 Special Comment PLEASE COMPLETE DETAILS AT THE END OF THE FORM TOTAL PRICE Total Price: Page 4 of 6

5 Non Conforming Options: BXA mm Backrest joint position BXA0390 Flex 3 backrest, plate width adjustable BXA0400 Flex 3 backrest, tension adjustable width adjustable BXA0410 Backrest tubes without backrest BXA0420 Flex mm Backrest adjustment BXA0430 Flex mm Backrest adjustment BXA0450 Cover, Lateral BXA0460 Cushion, Laguna (lateral support) BXA0470 Cushion, Mistral 2 (waist support) BXA0480 Cushion, Passad 2 (shoulder support) BXA0490 Cushion, Shoulder High 05 (dartex) BXA0520 Black Plush TR35 Backrest upholstery BXA0530 Black Dartex TR26 Backrest upholstery BXA0550 Push handles divided BXA0560 Push handles connected BXA0640 Low position Standard BXA0650 High position, mounted 50mm higher BXA0660 Hanger angle adjustable - alu 2008 LH. With knee pad and calf support BXA0670 Hanger fixed 80 deg, swing in swing out - alu 2003, LH BXA0680 Hanger fixed 90 deg, swing in swing out - alu 2003, LH BXA0690 Legrest amputee - alu 2008 LH BXA0710 Hanger angle adjustable - alu 2008 RH. With knee pad and calf support BXA0720 Hanger fixed 80 deg, swing in swing out - alu 2003, RH BXA0730 Hanger fixed 90 deg, swing in swing out - alu 2003, RH BXA0740 Legrest amputee - alu 2008 RH BXA0760 Footrest one piece depth and angle adjustable short tube. BXA0770 Footrest one piece depth and angle adjustable long tube. BXA0790 BXA0810 BXA0830 BXA0850 BXA0980 Footrest lower part, depth and angle adjustable with short tube and heel strap, LH Footrest lower part, depth and angle adjustable with long tube and heel strap, LH Footrest lower part, depth and angle adjustable with short tube and heel strap, RH Footrest lower part, depth and angle adjustable with long tube and heel strap, RH Pad, side rest BXA1010 BXA1020 Seat plate extension plates, 2 pieces. Width, forward, rear or assymetric 2 cm seat height increased seat plate BXA1040 Headrest, sidewise adjustable BXA1050 Cover for headrest BXA1060 Headrest with cheek support, sidewise adjustable BXA1070 Neckrest BXA1072 3rd party headrest bracket BXA1080 Cover for neckrest BXA1090 Handles clinic kit for head-/neckrest BXA1100 Trunk support multi adjustable with standard arm (LH) BXA1110 Trunk support multi adjustable with standard arm (RH) BXA1120 Trunk support multi adjustable with extended arm in height (LH) BXA1130 Trunk support multi adjustable with extended arm in height (RH) BXA1200 Trunk support multi adjustable swingaway (LH) BXA1210 Trunk support multi adjustable swingaway (RH) BXA1220 Trunk support attachment BXA1230 Lumbar support cushion BXA1240 Wedges (one pair) BXA1250 Privacy attachment BXA1270 Footplate extender LH BXA1280 Footplate extender RH BXA1290 Calf strap (for footrest one piece) BXA1300 Foot plate padding BXA1310 Calf support padded BXA x27 medium hard (4") front castor BXA x27 medium hard (5") front castor BXA x37 soft front castor BXA mm x 27mm medium hard castor BXA x30 soft front castor BXA x27 medium hard front castor BXA x30 soft front castor BXA x45 medium hard front castor Page 5 of 6

6 BXA1710 BXA1720 BXA1730 BXA1740 BXA1750 BXA1800 BXA1860 Table tray incl mounting kit Table cushion Swing away table Locking device for table tray Mounting kit for table (if ordered separately) Clinic kit Accessories/Ventilator tray Special Instructions: Please supply the following information Name: Phone: Description of special request (please include relevant option code): Page 6 of 6