Custom Contoured Seat Order Form - MSRP ONE Fabric Style For Contact Surface Select ONE Fabric Style For Non-Contact Surface
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www.icrehab.com version 5-14
Custom Contoured Seat Order Form - MSRP
Page OnePhone 800.676.5030
Fax 330.545.6389
Office Use Only:
Knob Release Kit (2-Point Mount)................................. #13007-15
One Inch Drop, U-Clamp Hardware Mounting Kit........... #2200-99
Velcro Hook & Loop Attachment (seat pan mount) ...... #13009-PM No Charge
Omit Mounting Hardware................................................ ($35.00)
Mounting Hardware-Options
Foam In Place Kits1/2 unit size..........................................................................#13011-FIP
1-full unit size.....................................................................#13011-FIP2
Soft Sunmate
Soft SunmateMedium Sunmate
Medium Sunmate
Qty:
Qty:
A-
B-
C-
D-
E-
F-
G-
H-
I-
J-
1" Drop Hook Kit............................................................ #2211-99
2" Drop Hook Kit............................................................ #2213-99
3"Drop Hook Kit.............................................................. #2215-99
No Charge
No Charge
No Charge
Flush-Mount U-Clamp Hardware Mounting Kit...............
Cushion Separated from wood.............................#13007-22 $128.00
Full-Width Custom Contoured Seat................#13003-SA
Seat-Mount InformationStandard
Oversized Seat Upgrade..................................... #13007-05 $114.00Actual Seat width 20-23" or > 20" deep
Between-The-Rails-Custom Contoured Seat.....#13003-SA
Mounting Location Flush Mount 1" Drop 2" Drop 3" Drop
No ChargeSeat width will be 3'' narrower than chair width
Seat Contour-OptionsNote- Standard foam contour selection will pre-determine ABD/ADD and the Anti-thrust heights inside cushion. Custom dimensions can be made in-lieu or in-junction with the standard foam contour selections. Custom dimension selections will override standard contour selections.
Mild Foam Contours (1/2 inch build-ups)
Moderate Foam Contours (1 inch build-ups)
Aggressive Foam Contours (1-1/2 inch build-ups)
Custom Contoured Seat................................#13003-SA...........$965.00
Track Mount Hardware............................... #13010-TM2
T-Nut for Attachment ................................................................ No Charge
Omit Track & T-nuts..................................................................... ($6.00)
Omit Wood ................................................................................. ($6.00)
A-
B-
Seat Tubing Size7/8" Tubing Size1" Tubing Size
QUOTE ORDER PO#
Other :
Company Name:
Phone #
Client Name:
W/C Make:
W/C Model:
W/C Width:
Seat Depth:
Non-Rehab Frame
Contact Name:
Frame Color:
HCPC E2609
No Charge#2199-99
Knob Release Kit (4-Point Mount).............................. #13010-19 Standard
must be ordered with Back 2-point kit w/seat-to-back-brackets
No Charge
$154.00
$209.00
No Charge
NEW FEATURES! Includes: 4 -Point knob release mounting hardware, premium foam and Upholstery upgrade
Standard
Bariatric Seat Upgrade..................................... #13007-06 $155.00Actual Seat width 24"
Bariatric Oversized Seat Upgrade ...................... #13007-07 $201.00Actual Seat width 25-30"
Leg-Length discrepancy (Left or Right).............. #13005-LLD.........$67.00
Pelvic Obliquity Upgrade.....................#13005-OB.................No Charge
Wedge Upgrade.................................... #13008-WS...............No Charge
(choose multiple options)
Seat Rail Cut Outs (Full width drop in style seat)....#13007-15..... No Charge
www.icrehab.comversion 5-14
Page Two
I-Cut Seat ( For x-brace and hardware clearance).............#13007-13.......$84.00
Anti-Thrust.............(Included in price, use for dimensions of anti-Thrust)
A-
B-
A-
B-
C-
D-
E-
A-
B-
A-
B-
Seat Options Sheet
Notched Seat Upgrade (Growth Tail).......#13007-10...............$40.00
A-
B-
C-
F-
D-
E-
C-
D-
E-
F-
G-
H-
C-
D-
E-
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B-
C-
D-
E-
F-
A-
B-
C-
D-
Seat Notes:
www.icrehab.comversion 5-14
Page Three
1/2" Medium Polyurethane Foam .......... #13040-04 $15.001" Soft Polyurethane Foam.................... #13040-03 $15.00
1/2" Soft Polyurethane Foam................. #13040-02 $7.00
1" Medium Polyurethane Foam.............. #13040-05 $23.00
1/4" Soft Polyurethane Foam................. #13040-01 $5.00
(Mid-Layer Foam)
1/2" Soft Visco Elastic Foam ........................ #13040-08 $37.00
1" Soft Visco Elastic Foam............................ #13040-10 $73.00
1/2" Super Soft Visco Elastic Foam.............. #13040-06 $37.00
1" Super Soft Visco Elastic Foam ................ #13040-07 $73.00
1/2" Soft SunMate Foam........................ #13040-11 $49.00
1" Soft SunMate Foam............................ #13040-12 $97.00
1/2" Medium SunMate Foam.................. #13040-13 $49.00
1" Medium SunMate Foam..................... #13040-14 $97.00
Poly FoamsVisco Elastic
SunMate Brand Foam
1/2" Neoprene Foam .................................... #13040-15 $27.00
Neoprene Foam
1/2" Soft SunMate Foam ................... #13050-10 $49.00
1" Soft SunMate Foam ...................... #13050-11 $97.00
1/2" Medium SunMate Foam.............. #13050-12 $49.00
1" Medium SunMate Foam................. #13050-13 $97.00
1/2" Poly-Gel (Cubed) ................................. #13050-16 $320.001/2" Poly-Gel (Flat) ...................................... #13050-15 $320.00
1/2" Poly-Gel (Cubed) > 20" width or ht....... #13050-18 $402.001/2" Poly-Gel (Flat) > 20" width or ht. ......... #13050-17 $402.00
1/2" Poly-Gel Inlay (Cubed) ........................ #13050-20 $122.00Top Middle Bottom
1/2" Poly-Gel Inlay (Flat).............................. #13050-19 $122.00
Top Middle Bottom
SunMate Brand Foam
Polymer GelOverlay-full sheet
Inlay half-sheet
1/2" Medium Polyurethane Foam........ #13050-04 $15.00
(Top-Layer Foam)
1/2" Soft Visco Elastic Foam ........................ #13050-08 $37.00
1" Soft Visco Elastic Foam .......................
1/2" Super Soft Visco Elastic Foam.............. #13050-06 $37.00
1" Super Soft Visco Elastic Foam................. #13050-07 $73.001" Soft Polyurethane Foam ................ #13050-03 $15.00
1/2" Soft Polyurethane Foam ............. #13050-02 $7.00
1" Medium Polyurethane Foam...........
1/4" Soft Polyurethane Foam.............. #13050-01 $5.00Poly Foams Visco Elastic
1/2" Neoprene Foam........................... #13050-14 $27.00
Neoprene Foam
Foam Options & Upgrades
(Base-Layer Foam)
1/2" Medium Polyurethane Foam............ #13030-07 $15.001" Soft Polyurethane Foam..................... #13030-06 $15.00
1/2" Soft Polyurethane Foam.................. #13030-05 $7.00
1" Medium Polyurethane Foam............... #13030-08 $23.00
1/2" Soft Visco Elastic Foam......................... #13030-11 $37.00
1" Soft Visco Elastic Foam............................ #13030-12 $73.00
1/2" Super Soft Visco Elastic Foam ............. #13030-09 $37.00
1" Super Soft Visco Elastic Foam.................. #13030-10 $73.00
1/2" Soft SunMate Foam......................... #13030-13 $49.00
1" Soft SunMate Foam............................ #13030-14 $97.00
1/2" Medium SunMate Foam.................. #13030-15 $49.00
1" Medium SunMate Foam..................... #13030-16 $97.00
Poly FoamsVisco Elastic
SunMate Brand Foam
1.5" Etha-Foam...................................... #13030-03 $37.00
1" Etha-Foam ........................................ #13030-02 $25.00
1/2" Etha-Foam ..................................... StandardEtha-Foam (high density)
1/2" Neoprene Foam.................................... #13030-04 $27.00
Neoprene Foam
Foam Notes:
2 3/4" Single Chamber Cushion .................. #13060-V1 $320.002 3/4" Dual Chamber Cushion..................... #13060-V2 $320.00
VARILITE Air-Foam Floatation Insert
$23.00#13050-05 Standard
version 5-14
Page Fourwww.icrehab.com
Upholstery Options
Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Air-mesh Black-12 Neoprene Black-13Neoprene Velcro-Sensitive Black-14Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18
Select ONE Fabric Style For Contact Surface
Select ONE Fabric Style For Non-Contact Surface
Step-ONE
Step-TWO
Incontinent Inner-Liner Cover.............#13008-IC..........$122.00
Removable / Stretchy Slip Cover.......#13011-NC..........$150.00
Dual Slip covers.................................#13011-NC2........$300.00
Slip Covers / Liner's
Dartex (fabric Side) Black-10
Dartex Reversed (Smooth) Black-11
Air-mesh Black-12
Dartex (fabric Side) Black-10
Dartex Reversed (Smooth) Black-11
Choose Contact Surface Choose Non-Contact Surface
Upholstery Notes:
Dartex (fabric Side) Black-10Dartex Reversed (Smooth) Black-11Darlex Black-15Cordura Black-16Vinyl Black-17Naugaform Black-18
Deep Violet Vinyl-20Blue Sparkle Vinyl-21Gold Sparkle Vinyl-22Burgundy Sparkle Vinyl-23Hot Pink Sparkle Vinyl-24Fuschia Sparkle Vinyl-25Silver Sparkle Vinyl-26Charcoal Sparkle Vinyl-27Green Sparkle Vinyl-28Cascade Sparkle Vinyl-29
Dove Vinyl-40Graymist Vinyl-41Blue Vinyl-42Passion Purple Vinyl-43Blueberry Vinyl-44Butterscotch Vinyl-45Red Swirl Vinyl-46
Orange Vinyl-48Hot Pink Vinyl-49Sun Yellow Vinyl-50CrocusVinyl-51Sky Blue Vinyl-52Carbon Vinyl-53Greystone Vinyl-54Fern Vinyl-55Crocus Vinyl-56
Space Blue Vinyl-47
Colored Vinyls
http://www.icrehab.com/files/Section%2012-Upholstery_Colors.pdf
To view upholstery Colors, please click link below
Slim-fit Brackets Lever Release Hip Support Brackets
5x7 (Large)
(E0956) $78.00
(E0956 / E1028) $488.00
(Pair)(Pair)
version 5-14
Page Fivewww.icrehab.com
Hip Support Options
Note: All Lateral Pads Come Standard with 1/2'' Of neoprene Foam and STD Dartex upholstery unless stated otherwise.
Foam Upgrade Options #0099 $20.00
Choose Hardware...............................
2" Offset
1" Offset
0" Offset
5" Bracket
6" Bracket
Choose Pad Style........................
(1/4" ABS) Base Support (1/2" Wood) Base Support
Choose Size........................................
4x6 (Medium)
3x5 (Small)
Choose Foams....................
1/2" Medium Polyurethane Foam 1" Soft Polyurethane Foam
1/2" Soft Polyurethane Foam
1" Medium Polyurethane Foam
1/4" Soft Polyurethane Foam
1/2" Soft Visco Elastic Foam
1" Soft Visco Elastic Foam
1/2" Super Soft Visco Elastic Foam
1" Super Soft Visco Elastic Foam
1/2" Soft SunMate Foam
1" Soft SunMate Foam
1/2" Medium SunMate Foam
1" Medium SunMate Foam
Poly Foams
Visco Elastic
SunMate Brand Foam
1/2" Neoprene Foam ..........................(standard)
Choose Upholstery...............
Match Upholstery of Seat ..........................(standard)
Included in back upholstery price
Lateral Upholstery Notes:
Other (explain below)
STD Dartex
Reversed Dartex
Add on top of standard foam...............(standard option)
Replace standard foam..................choose multiple options below
Rectangular Pads (wood only)
A-
B-A-
B-
C-
D-
Contoured Pads (wood only)
$118.00
$118.00
$118.00
$160.00 $160.00
www.icrehab.com version 5-14
Page Six
Removable Knee Adductor (E0956/E1028)
(One) 7/8" Frame-Mount Bracket........................#11067-E...................$329.00.
(Pair) 7/8" Frame-Mount Brackets......................#11067-2...................$658.00.
(One) 1" Frame-Mount Bracket...........................#11068-E...................$329.00.
(Pair) 1" Frame-Mount Brackets........................#11068-2...................$658.00..
Hanger-Mount Knee Adductors(Polymer-Gel pad(s) and hardware included)
Fixed Knee Adductor (E0956)
"Knee Button" Style Adductors (E0956)
(Pair) "Knee Button" Adductors Brackets.............#11066................$145.00..
Small Pad (A-3") (B-4") (C-3") (D-2.5") ..................................#11059-10.........$259.00
Medium Pad (A-4") (B-5") (C-3") (D-3.5") ................................#11059-11........$259.00
Knee Abductor "Econo-Removable" (E0957 / E1028)
(Pad and hardware included)
Large Pad (A-5") (B-6") (C-3") (D-4.5") ...................................#11059-12....... . $259.00
Custom Size Pad (specify dimensions below)....................................#11059-15.........$304.00.
Abductor Pad / Options / Upgrades
SunMate foam / dartex uph.................... (no charge)
Special foam / upholstery............... #0099................ $30.00
Small Pad (A-3") (B-4") (C-3") (D-2.5")..........................#11060-10........... $362.00Medium Pad (A-4") (B-5") (C-3") (D-3.5".........................#11060-11...........) $362.00
Flip-Down Knee Abductor (E0957 / E1028)
(Pad and hardware included)
Large Pad (A-5") (B-6") (C-3") (D-4.5")............................#11060-12.......... $362.00Custom Size Pad (specify dimensions below) ...........................#11060-15......... $410.00
A-
B-
C-
D-
A-
B-
C-
D-
Note:SunMate foam / reversed dartex uph......(no charge)
Knee Abductor Options
(One) 7/8" Frame-Mount Bracket........................#11064-E...................$301.00.
(Pair) 7/8" Frame-Mount Brackets......................#11064-2...................$602.00.
(One) 1" Frame-Mount Bracket...........................#11065-E...................$301.00.
(Pair) 1" Frame-Mount Brackets........................#11065-2...................$602.00..
Match Seat Surface / Sunmate Foam.....(standard)
Lower Extremity Options
Velcro Release (Pair) Adjustable mount
(E0951)
Large (10"-12" Circumference)......................#110451-L...................$156.00
Ankle Cuffs
Medium (8"-10"Circumference)......................#110451-M..................$156.00Small (6"-8" Circumference)..........................#110451-S...................$156.00
Side Release (Pair) Adjustable mount
Large (10"-12" Circumference)......................#110452-L...................$156.00
Medium (8"-10" Circumference).....................#110452-M..................$156.00Small (6"-8" Circumference)..........................#110452-S...................$156.00
Padded Velcro Release (Pair)
(E0951)
Adult...........................#11003...................$60.00
Toe / Ankle Straps
Youth..........................#11002...................$58.00Child...........................#11001...................$54.00
Non-Padded Velcro Release (Pair)
Xtra Large...................#11003-XL.............$60.00
Adult...........................#11006...................$31.00
Youth..........................#11005...................$31.00Child...........................#11004...................$31.00
Xtra Large...................#11006-XL.............$31.00
Heel Loops (Pair)
(E0951)
Adult...........................#11012...................$26.00
Heel Supports
Child...........................#11011...................$26.00
Heel Cups (Pair)
Adjustable...................#11012-1................$26.00
Non-padded...................#11013-X...............$126.00Padded..........................#11013...................$167.00
2-Piece Footbuckets
7" Padded..........................#11036-01X...................$430.00
6" Padded...........................#11036-00X...................$402.005" Padded...........................#11035-90X...................$402.00
(K0108)Footbuckets
10" Padded........................#11036-04X...................$450.00
9" Padded...........................#11036-03X...................$450.008" Padded..........................#11036-02X...................$430.00
1-Piece Footbuckets
16.5" Padded..........................#11037-02X...................$450.00
14.5" Padded...........................#11037-01X...................$400.0012.5" Padded...........................#11037-00X...................$400.00
Mounting Hardware
Omit Harware
1" Clamp mount brackets.................$75.007/8" Clamp mount brackets...............$75.00
Calf Panel Straps Hyper-Cel Dbl Velcro
20"-22" Frame..........................#11048-12...................$70.00
16"-19" Frame...........................#11048-11...................$70.0012"-15" Frame...........................#11048-10..................$70.00
Calf / Leg Supports
Calf Panel Straps Hyper-Cel Dbl Side Release
20"-22" Frame..........................#11048-22...................$70.00
16"-19" Frame...........................#11048-21...................$70.0012"-15" Frame...........................#11048-20..................$70.00
(K0108)
www.icrehab.com version 5-14
Page Seven
2-Point Seatbelts (Padded)
Pediatric 1" Side Release, 42" Length, STD pull (BA).......#11022-A2...........$57.00Pediatric 1" Pushbutton, 42" Length, STD pull (BA)..........#11022-D2...........$58.00
Positioning Seat Belts (E0978)
Youth 1.5" Side Release, 60" Length, STD pull (BA).........#11022-B4...........$60.00Youth 1.5" Pushbutton, 60" Length, STD pull (BA)............#11022-E4...........$69.00
Adult 2" Side Release, 80" Length, STD pull (BA).............#11022-C6...........$69.00Adult 2" Pushbutton, 80" Length, STD pull (BA).................#11022-F6...........$84.00
4-Point Seatbelts (Padded)
Youth 1.5" Pushbutton, 60" Length, STD pull (BA)............#11022-E22...........$96.00Pediatric 1" Pushbutton, 42" Length, STD pull (BA)..........#11022-A20...........$77.00
Adult 2" Pushbutton, 80" Length, STD pull (BA).................#11022-F24..........$88.00
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