Panther June 2016 Panther Script Form Fixed Frame Day Wheelchair 90200 Date Name Address Phone Fax / Cell Email Delivery details Therapist details Required by TRIAL CHAIR REF: Disability Weight Height Shoe Size T-Shirt Size To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the page. B C D I E J F G K M L H A N O P Pro T Front Style V Front Style A Seat Width B Seat Length C Back Height D Back Angleº E Seat to Footplate F Frame Length G Seat to Floor - Front H Seat to Floor - Rear I Balance Point J Castor Pivot Position K Castor Pivot Centres L Footplate Width M Camber (0º - 5º) Front Hanger Taper Style V Front Pro T Front Ergo Seat Option AD10220 N Ergo Seat Length O Ergo Back Height P Ergo Back Angleº MEASUREMENTS (Refer to diagram below) ADDITIONAL NOTES (you can type here) Frame Materials Aluminium (std) Titanium 90200T 5/12 Marriott Street, Oakleigh, VIC 3166 • Phone +61 407 502 729 • Fax +61 3 9077 4767 • Email: [email protected] • www.melrosewheelchairs.com.au
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Fixed Frame Day Wheelchair 90200 · 2019-01-20 · 28 Candy Red 11 Flame 57 Super Hot Chilli 80 Candy Orange 71 Pure Orange 68 Crystal Yellow 73 Crystal Jade 89 Fluro Green 70 Candy
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Transcript
Pant
her
June
201
6
Panther Script FormFixed Frame Day Wheelchair 90200
Date
Name
Address
Phone
Fax / Cell
Email
Delivery details
Therapist details
Required by
Trial Chair ref:
Disability Weight Height Shoe Size T-Shirt Size
To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the page.
ATTEnTIOnTHIS IS A guIDE TO COlOurS Only, how colours appear on your monitor or when printed out may vary. Contact us if you require assistance or a colour sample.This colour selection is for our aluminum frames only. We do not recommend powder coating titanium.Colour availability is subject to change without notice, contact us if you are concerned about the availability of your colour.