Company: ________________________________________________ Account Number: __________________ Date: _________________ q Quote q PO Number: ___________________________________ RTS: _____________________________________________________ Marked For: _______________________________________________ Ship To: __________________________________________________ Address: _________________________________________________ City: ________________________________ State: _____________ Zip: ________________ Phone: _____________________________ Email/Fax: ________________________________________________ Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth Seat Width 14” 15” 16” 17” 18” 19” 20” 21” 22” Price HCPCS N/C N/C N/C N/C N/C N/C $395 E2201 $495 E2201 $495 E2201 Seat Depth 14” N/C q q q q q q q q q 15” N/C q q q q q q q q q 16” N/C q q q q q q q q q 17” N/C q q q q q q q q q 18” N/C q q q q q q q q q 19” $80 q q q q q q q q q 20” $475 E2203 q q q q q q q q q Transit Option q Transit System __________________________________________________________________________________ $320 Not available with Removable Seat Pan or Heavy Duty Option Heavy Duty Option q 350 lb Weight Capacity __________________________________________________________________ $500 Requires minimum 6” caster height Cross Brace q Standard Cross Braces _____________________________________________________________________ Std q Seating System Cross Braces _______________________________________________________ N/C Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling. q Titanium Cross Braces ____________________________________________________________________ $600 Not available with 21” and 22” Seat Widths Rear Frame Type Catalyst 5 K0005 __________________________________________________________________________ $2075 300 lb weight capacity Phone (800) 981-1540 | Fax (715) 254-0996 [email protected]| www.kimobility.com Titanium Option q Titanium Frame K0108 _________________________________________________________________ $1650 Includes hangers and base frame. Does not include Cross Braces. DCN0268.8 Pricing and specifications subject to change without notice Page 1 of 9 No selection needed with Titanium Frame q Curved ____________________________________________________________________________________________________ Std Select from Standard or Angle Adjustable Back Posts on chart on the next page q Depth Adjustable K0108 _________________________________________________________________ $195 Select from Standard Depth Adjustable or Height Adjustable Depth Adjustable Back Posts in chart on the next page. Provides 2” forward and 2” rearward adjustment with minimum Seat Depth of 14” and maximum Seat Depth of 22”. Available only with T-Arm or Flip Up Armrests. q Reclining __________________________________________________________________________________________ $1095 Select from Reclining Back Post in chart on the next page. Not available with Seating Dynamics Rocker Back, O 2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm, Back Upholstery or IV Pole. Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 5). Requires Rear Anti-Tips. Not available with Spinergy wheels or Height Adjustable Flip Back T-Arm. q e-motion Ready __________________________________________________________________________________ N/C q twion Ready _________________________________________________________________________________________ N/C HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy. This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Seat Pan q Removable Aluminum Seat Pan E2231 _____________________________________ $245 Not available with Transit System. Pan depth 1/2” shorter than Seat Depth. Effective 02/17/2020 Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
15
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q Transit System __________________________________________________________________________________ $320Not available with Removable Seat Pan or Heavy Duty Option
q Titanium Frame K0108 _________________________________________________________________ $1650Includes hangers and base frame. Does not include Cross Braces.
DCN0268.8 Pricing and specifications subject to change without notice Page 1 of 9
No selection needed with Titanium Frame
q Curved ____________________________________________________________________________________________________ StdSelect from Standard or Angle Adjustable Back Posts on chart on the next page
q Depth Adjustable K0108 _________________________________________________________________ $195Select from Standard Depth Adjustable or Height Adjustable Depth Adjustable Back Posts in chart on the next page. Provides 2” forward and 2” rearward adjustment with minimum Seat Depth of 14” and maximum Seat Depth of 22”. Available only with T-Arm or Flip Up Armrests.
q Reclining __________________________________________________________________________________________ $1095Select from Reclining Back Post in chart on the next page. Not available with Seating Dynamics Rocker Back, O2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm, Back Upholstery or IV Pole.
Wheelchair Drive ReadyChair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 5). Requires Rear Anti-Tips. Not available with Spinergy wheels or Height Adjustable Flip Back T-Arm.
HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Seat Pan
q Removable Aluminum Seat Pan E2231 _____________________________________ $245Not available with Transit System. Pan depth 1/2” shorter than Seat Depth.
Effective 02/17/2020
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Standard Back PostSelect option below only if a Standard Back Post option is selected on chart above
q Straight with Push Handle ________________________________________________________________ Stdq Straight without Push Handle ________________________________________________________ N/Cq 8º Bend with Push Handle ______________________________________________________________ $25
Not available with Short Back Height Range
q Straight with Fold Down Push Handle ______________________________________ $125Not available with Heavy Duty option
Depth Adjustable Back Post OptionsOptions below may be selected only if Standard Depth Adjustable or Height Adjustable Depth Adjustable option is selected on chart above
q Stroller Handle Extensions ______________________________________________________________ $75Not available with Height Adjustable Depth Adjustable Back Posts
q Seating Dynamics Rocker Back K0108 __________________________________ $1995Available only with T-Arms
Push Handle OptionsNot available with Standard Depth Adjustable Back Post, Straight Back Post with Fold Down Push Handle, Reclining Back Post or Heavy Duty Option
q Low Profile Push Handle _________________________________________________________________ $652” shorter than standard push handles
Military Patch
Back UpholsterySelect option below only if Standard, Angle Adjustable or Height Adjustable Depth Adjustable Back Post option is selected on chart above. If selecting both upholstery and Axiom Back, the upholstery will be installed.
q Standard ________________________________________________________________________________________________ Std
Tension Adjustable E2611
q Standard Cover _____________________________ $245 q Air Mesh Breathable Cover ____________________ $390
q Omit Back Upholstery ___________________________________________________________________ - $10
Reclining Back Post OptionSelect options below if Reclining Back is selected on chart above. Recline angle range is 0º - 65º.
Gas Spring: q Standard Spring q Heavy Duty Spring
Select Back Height in row corresponding to desired Back Post and Height Range. Depth Adjustable not available with Titanium Frame.
Back Post Price Height Range Back Height
Standard N/C
Short 3,4 q 8.5 q 9.5 q10.5 q 11.5
Medium 4 q 12.5 6 q 13.5 q 14.5 q 15.5
Tall q 16.5 q 17.5 q 18.5 q 19.5
Angle Adjustable withPush Handle $185
Short 4 q 14 q 15 q 16
Medium 4 q 16 q 17 q 18
Tall q 18 q 19 q 20
Standard DepthAdjustable N/C
Short q 20
Tall q 24
Height Adjustable 2Depth Adjustable
$75
Short 1 q 13 q 14 q 15 q 16 q 17
Medium q 16 q 17 q 18 q 19 q 20
Tall q 20 8 q 21 5 q 22 5 q 23 5 q 24 5
Reclining with 1,7
AdjustableHandle (Removable)
N/CShort q 22
Tall q 261 Not available with Seating Dynamics Rocker Back2 Not available with Standard Back Upholstery3 Not available with Tension Adjustable Back Upholstery4 Not available with Standard Back Upholstery in combination with 20”-22” Seat Widths5 Not available with Tension Adjustable Back Upholstery in combination with 14” and 15” Seat Widths6 Not available with Tension Adjustable Back Upholstery in combination with 22” Seat Width7 Not available with O2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm or IV Pole8 Not available with Angle Adjustable Locking Extendable Flip Up Armrest
DCN0268.8 Pricing and specifications subject to change without notice Page 2 of 9
Attached only if ordered with Tension Adjustable Back Upholstery
US Military Service Patch _______________________________________________________________________ $90 q Army q Navy q Marines q Air Force q Coast Guard
q US Purple Heart Patch _____________________________________________________________________ $90
Purple Heart with Military Service Patch Combo __________________________ $145 q Army q Navy q Marines q Air Force q Coast Guard
Footrest / Extension / Seat to Footrest LengthSelect Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hangers and Fixed Front Frame measurements are based on 70º Hanger / Front Frame Bend.
Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.51 Not available with Titanium Frame. See Minimum Front Seat Height chart below.
Minimum Front Seat Height with Front Mount Hangers
Hanger Length Short Medium Long
Hanger Bend 70º 80/90º 70º 80/90º 70º 80º
Minimum Front Seat Height with Standard Selection
13.5” 13.5” 14” 15” 16” 17”
Minimum Front Seat Height with 3” Extension
14.5” 16” 16.5” 18” 18.5” 20”
3” ExtensionAvailable only with Front Mount Hangers. Provided as parts.
q 3” Extension for Front Mount Hanger __________________________________________ $35
Hanger ReleaseIf no selection is made Classic Hanger Release will be used
q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C
See reference A below. Not available with PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below. Not available with PRO ELR.
A B
DCN0268.8 Pricing and specifications subject to change without notice Page 3 of 9
Footrest
Hanger / Front Frame Bend
q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers. Not available with Titanium Frame.
q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with Titanium Frame or 7” and 8” Casters.
q Pro Elevating Leg Rests (PRO ELR) E0990 _______________________________ $295q Omit Hangers ___________________________________________________________________________________ - $20
Footplate
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or 14” Seat Width
q 1” Pneumatic _______________________________________________________________________________________ $80Available only with 6” and 8” Caster Sizes
q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 7” and 8” Caster Sizes
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Not available with 7” and 8” Caster Sizes
q 2” Poly ___________________________________________________________________________________________________ $70Available only with 6” Caster Size
q 2” Pneumatic w/ Foam Insert ______________________________________________________ $225Available only with 8” Caster Size
Caster Size / Front Frame Type / Front Seat Height
Fork Options
Fork Stem
q Best Fit ___________________________________________________________________________________________________ StdKi Mobility will pick Fork and Stem combination to optimize performance based on Caster Size and Front Seat Height
q Frog Legs Ultra-Sport Fork - Black ____________________________________________ $425Available only with 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.
End User Weight Required: ____________ lbsq Frog Legs PHASE 2 Carbon Fork ______________________________________________ $425
Lightweight shock absorbing fork. Available only with 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.
q Caster Pin Locks K0073 _________________________________________________________________ $195Not available with Performance Caster Housing, 1 1/2” Longer Fork Stem or Frog Legs Fork
Depending on configuration, chairs with Fixed Front Frame Type may achieve up to an additional .75”
Select Front Seat Height in row corresponding to desired caster size.Note: Selections in first three Front Seat Height columns use Super Low Front Frame. Super Low Front Frame not available with Titanium Frame or Fixed Front Frame.
8” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 211 Front Seat Height not available with 4 x 1” Poly Caster2 Super Low Front Frame required when using 4 x 1” Poly Caster
DCN0268.8 Pricing and specifications subject to change without notice Page 4 of 9
q Left _____________ $395 q Right ____________ $395 q Omit Left Hanger _ -$10 q Omit Right Hanger _ -$10
Cover ______________________________________________ q Smooth q Air Mesh q Smooth q Air Mesh
Pad Size ___________________________________________ q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14
q Superlight Spoke _____________________________________________________________________________ $265Available only in 24” and 25” wheel sizes. 25” wheel size available only with Superlight and Plastic Coated Handrims. Not available with Heavy Duty Option.
Spinergy Spox _________________________________________________________________________________________ $795Not available in 20” wheel size
Color: q Black q Red q White q Blue q Yellow
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Spinergy LX ______________________________________________________________________________________________ $995Not available in 20” wheel size
Color: q Black q Red q White q Blue q Yellow
q Pink q Green q Orange q Purple
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Axle Plate
Rear Seat Height and Wheels
Wheel Size / Tire Profile / Rear Seat Height
One Arm Drive
Select Rear Seat Height in row corresponding to Wheel Size and Tire Profile. 14” Seat Depth not available with 24”, 25” or 26” wheel sizes. m Requires Universal Axle Plate q Any axle plate can be used (Universal, Amputee, One Arm Drive)
Wheel Size
Tire Profile Rear Seat Height
20”Low m 113 m 11.5 q 121 m 12.5 q 131 m 13.5 q 14 m 14.5 q 15 m 15.5 m 16 m 16.5
Full m 11.53 m 12 q 12.51 m 13 q 13.51 m 14 q 14.5 m 15 q 15.5 m 16 m 16.5 m 17
22”Low m 123 m 12.5 q 131 m 13.5 q 141 m 14.5 q 15 m 15.5 q 16 m 16.5 m 17 m 17.5
Full m 12.53 m 13 q 13.51 m 14 q 14.51 m 15 q 15.5 m 16 q 16.5 m 17 m 17.5 m 18
24”Low m 133 m 13.5 q 141 m 14.5 q 151 m 15.5 q 16 m 16.5 q 17 m 17.5 m 18 m 18.5
Full m 13.53 m 14 q 14.51 m 15 q 15.51 m 16 q 16.5 m 17 q 17.5 m 18 m 18.5 m 19
25” Low m 13.53 m 14 q 14.51 m 15 q 15.51 m 16 q 16.5 m 17 q 17.5 m 18 m 18.5 m 19
26”Low m 143 q 151,2 m 15.5 q 161 m 16.5 q 17 m 17.5 q 18 m 18.5 m 19 m 19.5
Full m 14.53 m 15 2 q15.51,2 m 16 q 16.51 m 17 q 17.5 m 18 q 18.5 m 19 m 19.5 m 201 Not available with Amputee Axle Plate2 Not available with Height Adjustable Flip Back T-Arm3 Not available with Depth Adjustable Rear Frame Type, Reclining Rear Frame or Height Adjustable Flip Back T-Arms
No selection needed with One Arm Drive
m Universal ________________________________________________________________________________________________ Stdq Amputee _____________________________________________________________________________________________ $175
Not available with Swing Away Armrests or Wheelchair Drive Ready Option. Required with Reclining Backrest.
Wheel Locks
Wheel Lock
q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Low Profile Scissor Lock _________________________________________________________________ $45
Not available with Low Poly, Full Poly or Sentinel Solid tires
q Short Thro Scissor Lock ________________________________________________________________ $110
D’s Locks _______________________________________________________________________________________________ $1210Available only with MAXX Performance and Spinergy wheels. Not available with SoftWheel. Option has an extended lead time.
q Extension Handles E0961 ________________________________________________________________ $67Available only with Push to Lock or Pull to Lock Wheel Locks
q Grade Aids E0974 _____________________________________________________________________________ $150Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic with Airless Insert tires
One Arm Drive E0958 __________________________________________________________________________ $1095Available only with Mag wheel. Not available with 14” Rear Seat Height in combination with 24” wheel size. Standard Handrim will be Aluminum Anodized. Axle not quick release.
DCN0268.8 Pricing and specifications subject to change without notice Page 6 of 9
Handrim
Handrim Option
q 3M Micro Grip _____________________________________________________________________________________ $65Available only on Superlight and Aluminum Anodized handrims
Not available on 20” wheel size or 22” Mag wheel. Not recommended with Mag wheel.
q Natural Fit LT Regular Grip ____________________________________________________________ $445q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $495q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $345q Natural Fit Standard Omit Grip ____________________________________________________ $345
Natural Fit Handrims Standard Handrims
Rear Seat Height and Wheels continued
No selection needed with One Arm Drive or SoftWheel
Axle
Axles
Axle Position
Rear Wheel Camber: q 0º q 2º q 4ºNo selection needed with One Arm Drive
Center of Gravity: q Rear q Center q Forward
No selection needed with One Arm Drive. Same axles will be used if SoftWheels are ordered as an additional set of wheels.
q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ StdNot available on 25” wheel size
q Full Poly 1 3/8” E2218 _______________________________________________________________________ N/CNot available on Superlight wheel or 25” or 26” wheel sizes
q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $80Not available on Superlight wheel or 25” wheel size
q Schwalbe HS-127 1 3/8” E2211, E2212 ______________________________________ $125Available only on 24” wheel size. Not available on Mag wheel.
q Euro Trek Knobby 1 3/8” E2211, E2212 _________________________________________ $95Available only on 24” wheel size
Full Profile
q Low Poly 1” E2218 _____________________________________________________________________________ N/CNot available on Superlight wheel, 25” or 26” wheel sizes or Heavy Duty Option
q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95Not available on Superlight wheel or 20” and 22” Mag wheel
q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheel
q Schwalbe One 1” E2211, E2212 ____________________________________________________ $125Not available on Mag wheel, 20”, 22” or 26” wheel sizes
q Schwalbe Marathon Plus Evolution 1” E2211, E2212 ______________ $125Not available on Mag wheel, 20” or 22” wheel sizes
Low Profile
Same tire will be used if SoftWheels are ordered as an additional set of wheels
Available only in 24” and 25” wheel sizes. Not available with Heavy Duty Option. Same wheel size will be used if SoftWheels are ordered as an additional set of wheels. Selection required in Wheel Size / Tire Profile / Rear Seat Height chart on page 5.
Available only in 24” wheel size. Not available with thumb grip.
q Natural Fit Standard ________________________________________________________________________ $345q Natural Fit LT _____________________________________________________________________________________ $345
q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” wheel size, Mag wheel or SoftWheel
q Cane and Crutch Holder _______________________________________________________________ $195q IV Pole _________________________________________________________________________________________________ $265
Available only with Curved Rear Frame Type and Straight Back Posts
O2 HolderNot available with Depth Adjustable Rear Frame
O2 Holder E2208 ______________________________________________________________________________________ $295 q Right Side q Left Side
Not available with T-Arms, Flip Back or Swing Away with Side Guard Armrests
q Composite Side Guards K0108 ____________________________________________________ $140
Aluminum Straight K0108 New! q Black Matte _________________________________ $195 q Match Frame Color __________________________ $245
Not available with Hydrographics or Titanium Frame
Aluminum Adjustable Fender with Foam Pad K0108
q Black Matte _________________________________ $275 q Match Frame Color __________________________ $325
Not available with Hydrographics or Titanium Frame
q Flip Back (10.5”) ____________________________________________________________________________________ N/CNot available with Seat Depths less than 16”. Available only with Standard Back Post.
q Angle Adjustable Locking Extendable Flip Up E0973 ____________ $265Available only with Depth Adjustable and Reclining Back Posts
Armrests
q Swing Away (10.5” - 12.5”) E0973 _____________________________________________________ $195Available only with Standard Back Post. Not available with Arm Pads.
q Swing Away with Side Guard (10.5” - 12.5”) E0973 _____________________ $285Available only with Standard Back Post. Not available with Arm Pads.
1 Black is no charge2 Available only if corresponding option selection was made3 Not available with 2” wide casters, Frog Legs Ultra-Sport or PHASE 2 Carbon
Forks
Frame Color
Matte Frame Finish
Gloss Frame Finish
q Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Military Green ______________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C
q Black ______________________________________________________________________________________________________ N/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Fuchsia __________________________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C
Hydrographics Frame FinishVisit www.kimobility.com for current Hydrographic options. Note selection below
q $595
Frame Color not available with Titanium Frame Option
Colored Anodizing Package
DCN0268.8 Pricing and specifications subject to change without notice Page 9 of 9
17.5 16 18 16.5 18.5 17 20.5 n/a 8” x 2” caster not available with 6” fork17.5 16.5
3/418.5 17 19 17.5 20 18.5
1 1/218 17 18 17
1 1/2
19.5 18 20.5 19
18.5 171 1/2
18.5 17.5 18.5 17.5
3/4
21 n/a
19 17.5 19 18 19 18
18 17Std
7”
18 16.5
Std
7”
19.5 18.5
18.5 17.5 18.5 17 20 19
19 17.53/4
19 17.5 19.5 18
1 1/219.5 18 18.5 17.5
3/4
20 18.5
19.5 18.51 1/2
19 18 20.5 19
20 19 19.5 18.5 21 n/a
19.5 18
1 1/2
6” x 2” caster not available with 5” fork
20 18.5
20.5 19
1 Front Seat Height not available with 4 x 1” Poly Caster 2 Not available with 4 x 1” Poly, 4 x 1.5” Poly or 4 x 1.5” Soft Roll Aluminum
Seat heights with “FSH” heading available with Standard Front Frame. Seat heights with “Super Low” heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration.
DCN0537.0 Pricing and specifications subject to change without notice Page 1 of 1
q Axiom G Extra Outer Cover ____________________________________________________________ $75q Axiom S Extra Outer Cover _____________________________________________________________ $85q Axiom P Extra Outer Cover _____________________________________________________________ $95q Axiom SP Extra Visco Outer Cover ____________________________________________ $105q Axiom SP Extra Fluid Outer Cover _____________________________________________ $105
q Axiom SP Extra Visco Inner Cover _____________________________________________ $105q Axiom SP Extra Fluid Inner Cover _______________________________________________ $105
Select size in chart below. Weight capacity: 350 lbs.
Axiom Back Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.
Axiom Back continued Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.
Laterals for Posterior BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305 $153
q q q 3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS3x4P E0956, E1028 $650 $325
q q q 4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS4x5P E0956, E1028 $650 $325Laterals for Posterior Lateral BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF3x4L E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF4x5L E0956 $305 $153
q q q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS3x4L E0956, E1028 $650 $325
q q q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS4x5L E0956, E1028 $650 $325
DCN0538.0 Pricing and specifications subject to change without notice Page 5 of 5
Axiom Back Accessories continued
Selection of a modification from the Axiom Back Modifications section required in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144
q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144
q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144
q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113
q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113
q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113
q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167
q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167
q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167
q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167
q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167
q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169
q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169
q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169
q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169
q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169
Therafin Posture Support
Choose modification to add holes to the back shell in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Modification for 4 Point Harness AXM4PT K0108 N/C
q Modification for 2 Point Chest Strap AXM2PT K0108 N/C
q Modification for Shoulder GuidesIncludes shoulder guides
AXMSG K0108 $50
Axiom Back Modifications
Gloss Finish Item Code Retail
q Black AXMBLK N/C
q Blue Skies AXMSKY N/C
q Bubblegum Pink AXMPNK N/C
q Candy Blue AXMCBL N/C
q Candy Purple AXMPUR N/C
q Candy Red AXMRED N/C
q Copper AXMCOP N/C
q Granny Smith AXMGSM N/C
q Metallic Fuchsia AXMMTF N/C
q Metallic Orange AXMMOR N/C
q Silver AXMSIL N/C
q Teal AXMTEA N/C
q Yellow AXMYLW N/C
Painted Back Shell ModificationIf no selection is made, standard Shadow Black will be used with no additional lead time
Axiom Back Modifications Extended lead times will apply for all modifications