J6& J6 W/ PES Order Form 300 lbs. weight capacity Revised: September 25, 2012 Page 1 of 4 Client Height: Client Weight: A. Seat Width: B. Lateral Offset: C. Hip/Thigh Lateral Of fset: D. Center of Gravi ty: Optimized based on seat dimensionsE. Seat Depth:F . Back Height from Pan: G. Lateral Height from Pan: H. Armrest Height from Pan: I. Rigging Length (whole numbers only): J. Seat to Floor Height: qLowqMiddle qTall Clinician Notes: SPECIFIED DIMENSIONS * * While every effort will be taken to ensure items will be preset to your speci cations prior to shipping, variations in options may effect nal settings. Please supply patient information for optimal setup prior to shipping. Pride Mobility Products Corporation 380 V ansickle Rd. St. Catharin es, ON L2R 6P7 Phone: (888) 570-1 113 Fax: (866) 514-1303 Date: PO#: Account Number: Bill To: Address: Phone Contact: Ship To: Address: Marked For: Discount: Terms: Freight: LOWEST SEAT-TO-FLOOR HEIGHTS Contoured Seating 20.5” Specialty Seat 16.75” Synergy Seat 16.625” *(PES option adds approximately 1.5” to the lowest STF height listed.) Seating Lowest Seat-To-Fl oor
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3. Not available with Synergy Manual Recline, Synergy Manual Tilt, vent tray, baria
armpads, Tru-Comfort or sling back. May interfere with with lateral supports and
Waterfall Armpads.
4. Available with Tru Comfort seating only through SOF. Not available with SynergyManual Recline. Flip Back armrests may interfere with offset canes.
5. Interferes with swing-away laterals.
6. Adjustable from 11"-17" in 1/2" increments
7. Desk Length armrests with an accessory may interfere with access to headjustment lever. Adjustable Height from 7.75" to 9.75".
8. Height adjustment from 11-17" depends on cane height. Not available wManual Recline, Flip Forward back canes, Cane Clamp Pushbar, & ShapBack. Call for details when selecting aftermarket arm troughs or UniversSwivel.
9. TRU-ComfortTM Headrests are measured at the front of the headrest
(See Quantum accessories order form for additional options)
SYNERGY ® CUSHIONS
qNo Cushion RequiredPlease refer to Synergy order forms for detailed pricing and sizes.
Simplicity Cushion General Use
q16” x 16” - 20” x 20” $1Solution® 1 Cushion Skin Protection
q14” x 14” - 20” x 18” $2q20” x 20” $3Solution® Cushion Skin Protection & Positioning
q10” x 10” - 18” x 22” $3
q19” x 17” - 20” x 20” $4Solution® 1 LTC Cushion Skin Protection & Positioning
q14 x 16 - 20 x 20 $5Spectrum® Gel Cushion Positioning
q12” x 10” - 19” x 19” $5q20” x 16” - 20” x 20” $5Spectrum® Visco Cushion Skin Protection & Positioning
q10” x 10” - 19” x 19” $5q20” x 16” - 20” x 20” $5Spectrum Air Skin Protection q14” x 12” - 20” x 20” $5Spectrum Air Contour Skin Protection & Positioning q14” x 12” - 20” x 20” $6TRU-Comfort™ Seat Cushion General Use
q16” x 16” - 20” x 20” $3qPlus 4-way stretch material cover