Zippie IRIS July 2016 EIZ5A

Dte: Deler Acct #: Deler: Deler Cntct: Deler Address: Deler City: ST: Deler Phne: ( ) Fx: ( ) Cnfirm Vi: Mrk Fr: ZIP: Zippie IRIS July 2016 EIZ5A SUBMITTING FOR: Qute Order Ship T: Fx Emil Ship T Phne: ( ) Fx: ( ) PO#: Attentin: Address: Address: Ship T City: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. ST: ZIP: Optin # Definitin Optin # Definitin 188WM90 E1234 Zippie IRIS Flding Trnsit Optinl Includes True fit Grwth. NA with Mn 188GY01 188GY02 188FT46 188FS29 Frme Struts (Rigid Frmes Only) Fixed Struts (Grwth thru kits) NA W/Flding Width Adjusting system (built in grwth 2") NA w/ Mn Bck r Flding Frme Optins Cntrcture Set Frme (Nt Avil. w/10" Frme Depth r Flding Frme) Bttery Try (Nt vil. w/ 10" & 11" frme widths, ft wheel lck r Flding) $2,790.00 $45.00 1. FRAME * Cdes shwn s submitted. Sme sizes fit ther HCPC cdes i.e. 15-18 " widths = E1161 Bse Mdel (Rcker cver NA with flding) Trnsit (Fr use when Trnsit Optinl frme is selected) Mximum user weight is 225 lbs Mximum weight cpcity fr Z-Finity ftrests is 165 lbs 188TO45 Trnsit Optinl 188WM48 E1233 Zippie IRIS Trnsit Included $2,815.00 Tilt Relese Optins Includes True fit Grwth 188TT8 Ft Relese - (Nt Avil. w/ Vent nd 188WM47 E1233 Zippie IRIS Trnsit Optinl $2,665.00 Bttery Try. My limit flded width, flding Includes True fit Grwth frme defults t right side) Left Right (fcing frm rer) 188WM91 E1234 Zippie IRIS Flding Trnsit Included $2,940.00 188TT12 Dul Trigger Cble Relese Includes True fit Grwth. NA w/mn Pre-Set Tilt Angle (55 rnge) (Defult in Bld, NA w/ reclining bck) 188TA5-5 t 50 (Nt vilble. with 12.5" STFH.) 2. SIZE / SEATING 188TA6 188TA7 188TA9 188TA10 0 t 55 +5 t 60 Pre-Set Tilt Angle (40 rnge) (Defult in Bld) 188TA8-5 t 35 (Nt vilble with 12.5" STFH.) 0 t 40 +5 t 45 Frme Width (Custm set-up n 17" & 18" flding frme thru B4Me) 188W1 10" (NA w/ Mn) 188W2 11" (NA w/mn) 188W3 12" 188W4 13" 188W5 14" 188W6 15" 188W7 16" (Flding Grws t 18") 188W8 17"(Flding Grws t 18" B4Me custm set-up) 188W9 18"(N Grwth wi/flding B4Me custm set-up) 188ST35 188ST36 188ST54 188QC01 188QC02 Sets (NA w/ Flding Frme) E2231 Set Pn-Grwble (Fig. 8.1) E2231 Drp Set Pn Omit Set Pn Custm Seting Fr best perfrmnce seting shuld hve universl hrdwre JAY Surefit JAY Cnfiguerfit T rder ny JAY cushins n-chir, plese see the JAY price list. Cushin nme r prt number must be filled ut with desired width nd depth. 188JC20 Set Pn Size 10" - 16" 14" - 18" Nme / Prt # Width: JAY Cushins (Optinl) JAY Bundled Cushin Dim A Rnge 11-1/4" - 15-1/4" 15" - 19" REFEREE ONLY Depth: Figure 8.1 - Frme Depth Grwth Rnge Mtrix List ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 1

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 2. SIZE 1. / SEATING FRAME CONT. Frme Depth (Chse Selectins frm A OR B) Selectin A: Frme Depth Set up By Zippie Desired Set Depth 188SN01 10" 11" 12" 13" 14" 188SN02 15" 16" 17" 18" 188SN03 Bck Type 3" 2" 1" Flush -1" -2" 188FD1 This sectin determines frme length 2 1/2" r Greter Less thn 2 1/2" () Belw Set Ril Tp f Cushin t Set Ril Select frm A OR B 188FD2 188FD3 188FD4 188FD5 188FD6 188FD7 188FD8 188FD9 Selectin B: Frme Depth Rnge Shrt Set Frme 10"-14" Medium Set Frme 12"-16" Lng Set Frme 14"-18" Selectin B: Frme Depth 10" recmmended w/ Shrt Set Frme. Nt vil. with Cntrcture Ftrest System 11" recmmended w/ Shrt Set Frme. 12" rec. w/ Shrt Set Frme 13" rec. w/ Med. Set Frme 14" rec. w/ Med. Set Frme 15" rec. w/ Med. Set Frme 16" rec. w/ Lng Set Frme 17" rec. w/ Lng Set Frme 18" rec. w/ Lng Set Frme 3. CASTERS / SEAT HEIGHT 188CW31 Cster Wheel 4" Micr Light Up (NA with Flding) $70.00 Plese cll custmer service fr 13.25 n 12" RW nd 4" Cster (Rigid nly) Rer Wheel 4" x 1.25" Semi-Pneumtic (NA W/Flding) Size 4 5 6 8x1 8x 15.0 15.0 188CW34 6" Plyurethne 15.5 15.5 12 188CW35 6" x 1.5" Semi-Pneumtic $85.00 16.0 16.0 188CW21 E2214 8" Pneumtic $75.00 Lw Ply 16.5 16.5 16.5 16.5 E2215 13.5 CASTER SIZE 188CW73 1.5 8x2 188CW51 5" Micr Light Up $85.00 13.0 16.0 16.0 188CW5 5" Lw-Prfile Plyurethne 16.5 16.5 16.5 12 188CW7 5" x 1.5" Semi-Pneumtic $85.00 17.0 17.0 17.0 17.0 17.0 188CW33 E2214 6" Pneumtic $75.00 17.5 17.5 17.5 E2215 188CW32 8" Plyurethne 14.0 14.5 188CW39 8" x 1.5" Semi-Pneumtic $85.00 14.5 17.0 17.5 17.5 16 188CW36 E2214 8" x 2" Pneumtic $145.00 17.5 17.5 18.0 18.0 18.0 E2215 18.0 18.0 18.5 18.5 188CW37 E2214 8" x 2" Pneumtic $225.00 18.5 18.5 19.0 19.0 K0108 w/airless Insert 15.5 16.0 20 16.0 16.5 16.5 16.5 16.5 22 24 NA with Flding 16.5 17.0 17.0 17.0 17.0 17.0 16.5 16.5 17.5 17.0 17.0 17.0 17.0 18.0 17.5 17.5 17.5 18.0 18.0 18.0 18.0 17.0 17.5 17.5 17.5 18.0 18.0 18.0 18.0 18.0 18.5 18.5 18.5 18.5 19.0 19.0 19.0 ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 2

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 4. REAR WHEELS 1. FRAME / SEAT HEIGHT 188AL17 188OA2 188HM1 188HM2 188OA1 188HM1 188HM2 188AX26 188AX1 188AX11 E0958 One Arm Drive One Arm Drive NA with flding frme One Arm Drive (Avil. w/ 20", 22", 24" Mg Rer Wheels). Stndrd Hndrim Right Left Smll Hndrim Right Left Axle One Arm Drive Axle (Only vil. w/one Arm Drive Optin) Quick Relese Qud Quick Relese (nt vilble with Lite Spkes) $850.00 $125.00 188RT1 188RT2 188RT3 188RT4 188HR1 188HR4 188HR7 E2211 E2212 E2211 E2213 Rer Wheel Tire Pneumtic Pneumtic Airless Insert Full Plyurethne (Nt vil.w/ 12" & 16" rer wheels) Lw Plyurethne (Only vilble with 12" wheels ) Hndrim Aluminum Andized Plstic Cted Omit (Nt vilble with wheel/xle credit) Prjectins (Nt Avilble n Plstic Cted) Only vilble with 24" Mg wheels & nt vilble with spke gurds. $80.00 $95.00 188RW13 Rer Wheel Size 12" Mg (Nt vilble with hndrims) 188HR8 8 Oblique $325.00 188RW14 16" Mg (Nt vilble with hndrims) 188RW3 188RW8 188RW1 188RW90 188RW91 188RW54 20" Mg 22" Mg 24" Mg 20" Lite Spke 22" Lite Spke 24" Lite Spke $100.00 5. WHEEL LOCKS / HUB LOCK 188WL34 188WL36 188WL10 Wheel Lck Nt vilble with Hub Lck High Munt Push Ft Lck (NA w/ One Arm Drive. Flding frme defults t left side, my limit flded width) Omit Extensin Hndle 188EH1 E0961 6" Pir $75.00 Hub Lck *Only vilble with 12" r 16" wheels. Nt vilble w/ne rm drive. 188LK01 12" Hub Lck $100.00 188LK02 16" Hub Lck $100.00 ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 3

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 6. FOOTRESTS 1. (See FRAME Appendix fr mtrix) Hnger Munted Ftrest (Ftpltes Munt t Hnger Tubing) Ftrest Hnger Optins Hnger Type (Mtrix next pge fr Rnges) 188IG2 Neprene Cvers (Only vil. fr ext. $85.00 188H140 188H142 70 Swing In/Out Frnt Munt 80 Swing In/Out Frnt Munt 188HL1 E0951 munt hngers) Heel Lps (Z-finity NA widths 10"-14") $30.00 188H158 90 Swing In/Out Frnt Munt 188HL5 K0038 Leg Strp $35.00 188H9 70 Hvy Dty Fnt Munt Lift-Off 188A54 K0038 Extr Single Leg Strp $30.00 188H10 80 Hvy Dty Fnt Munt Lift-Off 188A110 E0952 Te Lp (Only vil. w/ dult ngle $40.00 188H11 90 Hvy Dty Fnt Munt Lift-Off djust. Ftpltes, NA w/z-finity) 188H161 E0990 Elev.Fnt Munt (n/ 10-11" wide) 188H32 Omit Hnger ($15.00) Extensins (my interfere with sme set heights & csters) 188F7 Omit Ftplte nd Ext. Tube ($15.00) 188E23 188E24 2" (nt munted) 4" (nt munted) Ftplte $55.00 $55.00 Z-finity Hngers/Ftrest System (Mximum weight cpcity fr Z-Finity ftrests is 165 lbs) 188F9 K0040 Kids Angle Adjustble (nt vil. w/17"- $185.00 Sme interference my exist in certin cnfigurtins. 18" widths) 188H162 Z-finity Hnger 188F8 K0040 Adult Angle Adj. $185.00 Z-finity Ftrest Munt (Must Chse see Illustrtin in ppendix) 188F62 K0040 (Avilble with 10"-18" widths) Ftbrd (Avilble with 10"-16" widths) $150.00 188DI22 188DI23 188DI24 Direct Hnger Mt/Fixed Frme - High Direct Hnger Mt/Fixed Frme - Lw Extensin Tube Munt Z-finity Ftrest Pivt Arm (Must Chse, use mtrix in ppendix fr leg length) 1" Offset NA with -5-50 nd -5-35 preset tilt ngle nd OR pssible interference with 80 & 90 hngers Ext. Tube Munted Ftrests (Ftpltes Munt t Ext. Tube) Hnger Type (Mtrix next pge fr Rnges) 188H145 60 Swing In/Out 188H139 70 Swing In/Out 188H141 80 Swing In/Out (n/ w/8" Csters) 188H159 K0053 Articulting (nt vil. 10"-13") 188H160 E0990 Elevting (Nt vil. w/ pltfrm ftpltes r < 14" width) 188E1 188E2 188E5 188E16 188F1 188F3 188F48 188MZ02 188MZ01 K0040 Ftplte Cmpsite (nt vil. In 10", 11" r 12" width) Adult Angle Adjustble (Avilble with 10"-18" widths) Aluminum (Only vilble with elevting legrests 14"-18") Pltfrm Flip-Up (Avil n 60 70 nd 80 ext. munt hngers nly. NA w/flding Frme) Hnger Munts Stndrd Hnger Munt 1" Offset Hnger Munt 188F4 K0040 Kids Angle Adjustble (nt vil. w/17"- $185.00 18" width) 188F5 Extensins (Mtrix next pge fr Rnges) Shrt Medium K0037 K0040 Lng High Munt $350.00 $55.00 $185.00 $190.00 Sme interference my exist in certin cnfigurtins. 188F320 K0040 Multi Angle Adjustble (Pir) (nt vil. w/8"-9" widths) 188F321 K0040 Angle Adjustble Pltfrm Ftbrd 188DI20 Shrt 2" 188DI21 Lng 3 1/4" $150.00 188F6 Omit Ftplte Z-finity ExtensinTube Length (When Chsing Ext. Tube Munt) 188E62 K0040 Hemi Shrt 188E1 K0040 Shrt 188E2 K0040 Medium 188E5 188JX01 188JX02 188JX03 188JX04 188JX05 188JX07 188JX08 188JX09 188JX10 K0040 Lng Z-finity Ftplte JAY FOOT BOXES Stndrd Height - Left Tll Height - Left Stndrd Height - Right Tll Height - Right Stndrd Height - Pir Tll Height - Pir Full Ft Bx Full Ft bx Std Height Full Ft bx Tll Height Full Ft bx w/ Divider Std Ht Full Ft bx w/ Divider Tll Ht $185.00 $225.00 $225.00 $225.00 $225.00 $450.00 $450.00 $350.00 $350.00 $400.00 $400.00 Only vilble with Swing Awy, Lift-ff Hngers,Adult Angle Adj Ftpltes nd ALR/ELR. Single Ft Bx pirs NA with 10"-15" frme widths. Full Ft bxes NA with Heel Lp r Leg Strp r in dd number sizes, Tll Height NA w/ 14"-15" frme widths nd ALR/ELR. NA w/ Z-finity. Single Ft Bx 188JX06 ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 4

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 6. FOOTRESTS CONT. 1. FRAME (See Appendix fr mtrix) Cntrcture Ftrest System (CFS) NA w/ Neprene Impct Gurds, Kids Angle Adj. Aluminum Ftrests, Dul Pst Armrest r Flding Frme. 188H26 Cntrcture Ftrest System $325.00 188E2 REGULAR 188FP01 CFS - Center Munt 188EP5 12.5" Extensin Height 188FP02 CFS - Outside Munt 188EP6 13.0" Extensin Height 188E1 SHORT 188EP7 13.5" Extensin Height 188EP1 10.5" Extensin Height 188EP8 14.0" Extensin Height 188EP2 11.0" Extensin Height 188EP9 14.5" Extensin Height 188EP3 11.5" Extensin Height 188EP10 15.0" Extensin Height 188EP4 12.0" Extensin Height 188EP5 12.5" Extensin Height 188EP6 13.0" Extensin Height 7. BACKREST / SEATING DYNAMIC BACKREST Dynmic Bckrest 188BT101 NA w/ Reclining r Flding Frme. NA in sme cnfigurtins. $1,195.00 Jy Bcks (Optinl) Ordering JAY bcks n-chir, See the JAY List. Requires Prt # JAY Bundled Bckrest 188JB02 Bckrest Nme r Prt # List Width: Height: STROLLER HANDLE BACK POSTS - BACK RESTS (Chse A, B, C r D) 188BP9 188BP10 188BP11 188BP13 188RG1 188B170 188PH8 188PH9 A. Fixed Height Lw (19" Ht) Medium (22" Ht) Tll (25" Ht) Remvble Extensin Flding Adjustble Rigidizer NA w/ Mn Bck OR B Height Adjustble Rigid Bck w/ Angle Adjust Push Hndle Std. (16"-22" Height.) Std. Angle Adj. Push Hndle Lgth Lng Angle Adj. Push Hndle Length $85.00 $175.00 A B Select One 188MO1 188MO2 OR C. Mn Bck System Must select JAY J3 when rdering Mn Bck. NA w/ Flding Frme. Mn Bckrest System Mn Bckrest System w/dynmic Bckrest AND Select desired Push Hndle 188PH8 Std. Angle Adj. Push Hndle Lgth 188PH9 Lng Angle Adj. Push Hndle Length OR $395.00 $995.00 C 188B171 188PH8 188PH9 Tll (19"-25" Height.) Std. Angle Adj. Push Hndle Lgth Lng Angle Adj. Push Hndle Length D. Reclining Bckrest Only vilble with 40 Tilt Rnge. NA w/flding Frme 188BT21 E1225 Reclining Bckrest $850.00 188B172 Medium (21" Height) 188B173 Tll (24" Height) D Reclining/Fixed Hndle Ht. Digrm Height Adj. Hndle Height Digrm ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 5

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 7. BACKREST 1. FRAME / SEATING CONT. Mn Bckrest Optins ONLY NA n Flding Frme, Vent/Bttery Try Bse(LTV nly), Reclining Bckrest, Desk Length Armpds, Cnpy nd 10"-11" frme widths nd depths. JAY J3 Bck fr Mn Bckrest System JAY J3 Bck fr Mn Bckrest System Cnt. 188JB04 JAY J3 Bck Mn See OF Select desired Hedrest Munt (ptinl) 188JB05 JAY J3 Bckrest Cntur JAY J3 vi JAY Yur Wy See OF 188MH10 188MH15 E1028 E1028 Axys Munt & Brcket Cbr Munt nd Brcket $230.00 $280.00 188JP06 E2613 J3 PA Bck (2.2" f Cntur Depth) $535.00 188MH16 E1028 Onyx Munt nd Brcket JAY J3 Bckrest Clr 188GZ01 188JP08 188JP09 188JP10 188JR07 188JR08 188JR10 E2615 E2620 E2620 JAY J3 Bckrest Height 188JR09 188JR11 188JR12 J3 PL Bck (3.0" f Cntur Depth) J3 PDL Bck (6.0" f Cntur Depth) J3 PDC Bck (6.0" f Cntur Depth) UT Stndrd 16.5" shell height UT Medium 18" shell height UT Tll 19.5" shell height SH Stndrd 21" Shell Height SH Medium 22.5" JAY J3 Bckrest Width Sme interference my exist w/ rmrest when rdering bckrest width greter thn 4" wider thn the bse. 188JQ06 188JQ01 188JQ02 188JQ03 188GZ02 188GZ03 SH Tll 24" 12" Bckrest Width (nly vil w/ut Stndrd 16.5" shell ht) 14" Bckrest Width 16" Bckrest Width 18" Bckrest Width Blck Mtch Frme- Stndrd Clrs Mtch Frme- Custm Clr $620.00 $745.00 $745.00 $50.00 188MH17 Omit Select desired Hedrest Pd (ptinl) 188HE65 188HE66 188HE78 188HE87 188HE88 Plush Hed Supprt Pd 8" Plush Hed Supprt Pd 10" Plush Hed Supprt Pd 14" HedsUp Lrg: 5.3" Lng Arms HedsUp Med: 4.1" Sht Arms 188HE89 HedsUp Sml: 3.5" Sht Arms 188HE83 188HE82 Adjust-A-Plush Stndrd Adjust-A-Plush Nrrw Select desired Lterl (ptinl) LAT 4X4 S/A MOUNTS includes 1" OFFSET - PR 188ZV14 E0956 LATERAL 4X4 W/ 1" OFFSET - PAIR LAT 4X5 S/A MOUNTS includes 1" OFFSET - PR 188ZV15 E0956 LATERAL 4X5 W/ 1" OFFSET - PAIR LAT 4X6 S/A MOUNTS includes 1" OFFSET - PR 188ZV16 E0956 LATERAL 4X6 W/ 1" OFFSET - PAIR LAT 6X4 S/A MOUNTS includes 1" OFFSET - PR 188ZV17 E0956 LATERAL 6X4 W/ 1" OFFSET - PAIR LAT 6X5 S/A MOUNTS includes 1" OFFSET - PR 188ZV18 E0956 LATERAL 6X5 W/ 1" OFFSET - PAIR LAT 6X6 S/A MOUNTS includes 1" OFFSET - PR 188ZV19 E0956 LATERAL 6X6 W/ 1" OFFSET - PAIR $230.00 $230.00 $230.00 $310.00 $310.00 $310.00 Mn Height Adj. Hndle Height Digrm ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 6

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 8. ARMRESTS 1. FRAME / SIDE GUARDS Armrest - Height Adjustble Dul Pst nt vilble with 0-13" deep r with 14-15" deep set pn, Dul Pst ls nt vilble with cntrcture Ftrest. Sme interference my exist in sme cnfigurtins. 188AA12 188AA13 188AA3 188AA1 188AA7 188AA62 188AA63 188AA43 188AA48 188AA11 188AA29 188AA154 188AM23 188AM24 Length Adjust. Lcking Flip-Up NA with Cntur Armpd Dul Pst Dul Pst Height Adjustble Dul Pst Flip Bck Dul Pst Flip Bck Height Adj. Single-Pst Height Adj. Std. Single-Pst Height Adj. Lw Height Adj. Cntilever Armrest Avil. w/ Mn Bck nly. NA w/ 20", 22" nd 24" rer wheels. ARMPAD Cntur nly w/ Single Pst Height Adj. Fm nly Lengh Adj. 188AM21 188AM22 188AM9 188AM10 T-Pst Regulr w/fm T-Pst Tll w/fm Flip-Up Adjustble Lcking Flip-Up Desk Clssic Desk Cntur Full Clssic Full Cntur Fm Shrt Fm Lng $255.00 $265.00 $270.00 $95.00 $285.00 $285.00 JAY Arm Trughs NA with Length Adj. Lcking Flip Up nd Adj Lcking Flip Up rmrests nd Single Pst Height Adj Armrests. Full Length Clssic Armpds will utmticlly be selected when chsing nly ne side Arm Trugh. 188JL01 188JL04 188JL05 188JL02 188JL06 188JL07 188JL03 188JL08 188JL09 188JN01 188JN03 188JN02 188JN04 E2209 E2209 Arm Trugh - 18" lng - Left E2209 Arm Trugh - 18" lng - Right E2209 Arm Trugh - 18" lng - Pir E2209 Arm Trugh - 22" lng - Left E2209 Arm Trugh - 22" lng - Right E2209 Arm Trugh - 22" lng - Pir JAY Arm Trugh - Hrdwre Fixed (EA) Fixed (Pir) E1028 Swing Awy - Rttinl (EA) E1028 Swing Awy - Rttinl (Pir) $500.00 Plstic Std Plstic Lw $410.00 $410.00 Side Gurd Nt vilble with height djustble rmrests, T Psts r Cntilever rmrests. NA w/ Mn Bck. 188SG33 188SG29 E2209 E2209 K0108 K0108 Arm Trugh - 14" lng - Left Arm Trugh - 14" lng - Right Arm Trugh - 14" lng - Pir $410.00 $125.00 $125.00 Armrest Receiver fr Single Pst Height Adjustble Armrest 188AR17 Lw 188AR18 Std Armrest Size Trnsfer Tube Length D 8" LOW 5 1/4" CLASSIC PAD Receiver Pd Length L H Rnge Desk Full 10 3/4" t 15 3/4" LOW 8 3/4" t 13 3/4" 10 1/4" 14" 9" t 13" LOW 7 1/4" t 11 1/4" CONTOUR PAD Receiver Pd Length L H Rnge Desk Full 10" t 15" LOW 8 1/4" t 12 1/2" 10 1/2" 14 1/4" 8 1/2" t 12 1/2" LOW 6 3/4" t 10 3/4" Armrest Mtrix fr Single Pst ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 7

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin 9. ACCESSORIES 1. FRAME 188A1 188A2 188A8 188A83 188A112 188A117 188A118 188A141 188A814 188LF12 188LF13 188LF7 Bck Pck (Kids Bckpck included) All Zippie chirs ship with ne Kids Bckpck t Utility Bckpck - Blck Additinl Zippie Bckpck Blck Tl Kit Set Puch Miscellneus Psitining Belt (w/clmps) $55.00 $50.00 $45.00 $45.00 E0978 1" Dul Pull Side Squeeze Pdded $85.00 E0978 Belt 2" Aircrft Buckle $110.00 E0978 Belt 2" Aircrft Buckle Pdded $120.00 E0978 Belt 1.5" Aut Buckle w/clmps $70.00 E0978 JAY 2 Pt Anterir Pelvic Belt 1" Push Btn $120.00 Verticl Munt Vent Try-Bck cne Munt E1029 Dvetil Verticl Frme Munted Hrdwre fr LTV Vent (limit 15#) includes 1 Utility $495.00 Hk. Must remve fr flding. E1029 Dvetil Verticl Frme Mt Hrdwre fr Trilgy Vent (limit 15#) includes 1 Utility $495.00 Hk Must remve fr flding. Utility Hk $25.00 Need 2" bck pst clernce t munt cnpy hrdwre, my require next height bsed n seting; plese nte sme interference my ccur with sme hedrest cnfigurtins. NA with Mn Bck. Must remve fr flding. 1888A06 1888A07 K0108 K0108 Cnpy (Sunshde) 10"-14" Width Cnpy (Sunshde) 15"-20" Width $275.00 $275.00 188JY01 188JY02 188JY03 188JY04 188JY05 188JZ01 188JZ02 188JZ03 188JZ04 188JA01 188JA02 188JA03 188JA04 Cnpy (SunShde) JAY Anterir Thrcic Supprt Clssic Dynmic Clssic Structure Cntur Dynmic Center Opening with Buckle Smll Medium Lrge X-Lrge Style Size JAY Pdded Trunk Strp Pdded Trunk Strp - Smll Pdded Trunk Strp - Medium Pdded Trunk Strp - Lrge Pdded Trunk Strp - XL Cntur Structure Upper Extremity Supprt Try Spke Gurd When rdering try with full rmrest r desk rmrest pds, dd 1" t set width t Nt vilble with 12" & 16" rer wheels & Prjectins Hndrims determine best try size. NA with JAY Arm Trugh. Must remve fr flding. 188A23 K0065 Blck $115.00 188A29 E0950 X-Sm (Suggested 10"-12" Width) 188A303 K0065 Cler Zippie $115.00 188A30 188A31 188A32 E0950 E0950 E0950 Sm (Suggested 13"-14" Width) Med (Suggested 15"-17" Width) Lrg (Suggested 18"-20" Width) 188AT1 Anti-Tip E0971 Rer Anti-Tip $140.00 10. FRAME COLOR 188C140 Aztec Gld 188C116 188C2 Blck (Nt vil s bse w/zebr) 188C151 188C141 Blck Cherry 188C152 188C10 Blck Opl 188C150 188C38 Blue Opl 188C149 188C36 Cndy Blue 188C14 Cndy Purple 188C35 Cndy Red 188C43 188C142 Electric Blue 188C42 188C143 188C126 188C144 188C147 188C148 Evergreen Glw Green Apple Ht Sprkle Pink Muve Pink 188C108 188C103 188C114 188C145 188C113 188C8 Stndrd Clrs Rtbeer Sprkle Silver Sunrise Ornge Titnium Clr Pint Yellw Stndrd Mtte Clrs Mtte Blck Mtte Blck Cherry Mtte Purple Mtte Electric Blue Mtte Evergreen Custm Clrs Mssy Ok Cmuflge Strs nd Stripes Zebr (Chse bse clr bve: White Std, n/ blck) ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 8

Mrk Fr: The CODES prvided re bsed n cde verifictin thrugh PDAC r ur interprettin f the cde definitins. The use f CODES des nt ensure cverge r pyment. Fr cverge infrmtin, verify the pprprite pyer's cverge plicy. Optin # Definitin Optin # Definitin APPENDIX 1. FRAME Lwer Leg Length Mtrix Hnger 70 Frnt Munt Extensin Set Pn t Tp f Ftrest Min Mx Min Allwble FSH N Ext 3 1/2 9 11 1/2 2" 3 1/2 11 1/2 13 1/2 4" 3 1/2 13 1/2 15 1/2 N Ext 3 1/2 9 1/2 11 1/2 80 Frnt Munt 2" 3 1/2 12 14 4" 3 1/2 14 16 90 Frnt Munt N Ext 3 9 11 1/2 ELR Frnt Munt N Ext 3 7 10 1/2 Shrt 9 12 1/2 12 1/2 60 Swing In/Out Med 9 14 1/2 12 1/2 Lng 11 1/2 16 14 1/2 Shrt 10 1/2 15 1/2 12 1/2 70 Swing In/Out Med 10 1/2 17 1/2 13 Lng 13 1/2 19 15 Shrt 11 14 1/2 13 80 Swing In/Out Med 11 16 1/2 13 Lng 13 18 15 Shrt 14 17 1/2 12 1/2 ALR Med 15 19 1/2 13 1/2 Lng 16 1/2 19 14 1/2 Shrt 13 17 12 1/2 ELR Ext. Munt Medium 13 18 1/2 13 1/2 Lng 14 1/2 20 14 1/2 Direct Hnger Munt Z-finity Mtrix Extensin Tube Munt Additinl Optins Thrugh Built fr Me T inquire but ny unique custmiztin fr Quickie prducts, cntct: Phne: (800) 333-4000, Fx: (800) 333 9011 Direct Hnger Munted Hnger Ftrest Munting Adptr Psitin Min Mx Shrt High Munt -0.9 3.4 Lw Munt 2.6 6.7 Lng High Munt -2.1 4.6 Lw Munt 1.3 7.9 Extensin Tube Munted Extensin Ftrest Tube Adptr Length Min Mx Hemi Shrt 3.9 12.4 Shrt 4.9 13.4 Shrt Medium 6.6 15.4 Lng Lng 8.6 17.4 Hemi Shrt 2.6 13.6 Shrt 4.1 14.6 Medium 5.6 16.6 Lng 7.6 18.6 Cmmnly Requested Optins Include: Reverse Cnfigurtin Angle Adjustble Hndle fr Reclining Bckrest Dul Munt Wheel Lcks - Attendnt Ft Lck Dynmic Bck n Frme Depth up t 20" O2 Hlder with Trnsit IV Ple with Trnsit Slid Set w/ Quick Relese Hrdwre fr flding frme ORDER INFORMATION: Custmer Service: 800-333-4000 Fx: 800-300-7502 www.sunrisemedicl.cm Specifictins re subject t chnge withut ntice. Cpyright 2014 Sunrise Medicl MK-100012 REV.H Pge 9