Freestyle M11 Form PDF Details

When considering the needs of individuals requiring specialized mobility solutions, the Quickie Freestyle M11 with Perfect FitTM Seating system presents itself as a noteworthy option. Released in November 2005, this power wheelchair by Sunrise Medical incorporates a variety of features and options designed to offer a customizable and comfortable experience for its users. With its base model starting at $5,245, the chair is engineered to support a maximum user weight of 300 lbs and achieves a top speed of 5.5 mph. The Perfect FitTM power seating system is a highlight, offering adjustable seating solutions to meet changes in a user's mobility requirements, including adjustments for physical attribute changes and the addition of power seating options as needed. The order form details an array of choices from seating adjustments, electronics, power seat options, and additional accessories to ensure the wheelchair can be tailored to the specific needs of each user. Importantly, the document underscores the significance of accurate order information including account details and purchasing specifics, a standard process facilitated through Sunrise Medical's customer service via phone, fax, or their website. This comprehensive approach to custom wheelchair configuration not only emphasizes the product's adaptability but also represents the company's commitment to providing mobility solutions that fit the unique needs of individuals.

QuestionAnswer
Form NameFreestyle M11 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesM11, ELR, NC, m11 form

Form Preview Example

Quickie Freestyle M11 with Perfect FitTM Seating

EIPW8, EFFECTIVE NOVEMBER 2005

ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.com

ACCOUNT INFORMATION

Account No: ___________________________________________________

Date: __________________________________________________________

P.O. #: ________________________________________________________

Buyer: ________________________________________________________

Marked For: ____________________________________________________

FREESTYLE M11

 

 

 

135PC16

K0011

Freestyle M11 Standard Chair 6

 

$5,245.00

 

 

 

Standard Chair

300 lb 5.5 mph power wheelchair

 

 

 

 

 

 

High Back Comfort Seat 6

 

 

 

 

 

 

 

 

VSI 4-Button Integral Controls

 

 

 

 

 

Upgraded Seating

 

 

 

 

 

 

 

135ST38

 

Perfect FitTM Adjustable Seat Frame

 

$475.00

 

 

 

 

 

 

 

 

 

 

Shroud Color

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Quick-Change Shrouds

 

 

Std

 

 

 

All Colors Included: Candy Red, Blue, Black & Champagne

 

 

 

 

 

 

 

 

 

 

Drive Wheel

 

 

 

 

 

 

 

 

135DW1

 

10" Alum Rim w/Pneumatic Tire

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

135DW2

K0093

10" Alum. Rim & Solid Insert

 

 

$220.00

 

 

 

 

 

 

 

 

 

 

User Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Less than 150 Lbs

 

 

 

 

 

 

 

151 - 250 lbs

 

 

 

 

 

 

 

251 - 300 lbs8

 

 

 

 

 

 

 

 

 

ELECTRONICS

 

 

 

Joystick

 

 

 

 

 

 

 

 

135J23

 

Integral VSI 4-Button (70A) 3

 

 

Std

 

 

 

135J23

 

Integral VSI 6-Button (70A) 3,7

 

$200.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135J5

E2320

Qtronix Remote

 

1

$825.00

 

 

 

 

 

 

 

135J4

E2320

Qtronix Remote with 1/8" jacks

$985.00

 

 

 

 

Joystick Mount

 

 

 

 

 

 

 

 

135JM1

 

Fixed Mount

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135JM2

E1028

Swing Away Mount

2

 

$235.00

 

 

 

 

 

 

 

 

 

 

 

135JM3

E1028

Center Mount Swing Away

 

$235.00

 

 

 

 

 

 

 

 

 

Hand Mount

 

 

 

 

 

 

 

 

135HM2

 

Left

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135HM1

 

Right

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

Height Adjustable Mount

 

 

 

 

 

 

135HI01

 

Fixed Mount (Std)

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135HI02

 

Height Adjustable Mount

 

 

$95.00

 

 

 

 

 

 

 

 

 

 

 

 

Joystick Handle

 

 

 

 

 

 

 

 

135JH3

 

Stick Handle

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135JH1

E2323

Ball Handle

 

 

$75.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135JH2

E2323

Foam Ball Handle

 

 

$75.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135JH4

E2323

T-Handle

 

 

$75.00

 

 

 

 

 

 

 

 

 

 

Drop Ship/Ship To: _______________________________________________

Name: __________________________________________________________

Address: ________________________________________________________

City:State:_________________

Zip Code:____________ Phone Number:______________________________

The Perfect FitTM power seating system is a unique, modular and adjustable system that can easily accommodate changes in a User’s power mobility requirements:

-Seating can be adjusted when a User’s physical attributes change

-Power seating options can be be added as needed

-Proper fit for lower and upper body positioning is achieved independently to create the "perfect fit".

PERFECT FITTM POWER SEAT OPTIONS

 

 

135PA4

E1007

CG Tilt 50°& Pwr Recline, Mech. Shear2,8

$

9,995.00

 

 

135PA1

E1002

Power CG Tilt 50°

$

5,350.00

 

 

135PA3

E1004

Perfect FitTM Pwr Recline, Mech. Shear2,8

$

5,850.00

 

 

 

 

 

 

 

POWER SEAT OPTION ELECTRONICS

 

 

 

 

135TC1

 

Dual Toggle Activation & Control 4

 

Std

 

 

135TC5

 

Omit Dual Toggle 4

 

-$20.00

 

 

 

 

 

 

 

 

 

 

135TC6

E2310

Thru Drive 1 Power Seat Opt

 

$800.00

 

 

 

 

 

135TC10

E2311

Thru Drive 2+ Power Seat Opt 5

 

$1,550.00

 

 

 

 

 

 

 

 

 

 

BATTERIES

 

 

Batteries

 

 

 

 

 

 

135A46

E2365

U1 Gel Cell (Pair)

 

$230.00

 

 

135A150

 

40 Ahr AGM (Pair)

 

$290.00

 

 

 

 

 

 

 

 

Battery Charger

 

 

 

 

 

 

135BJ6

 

4A Charger (On-Board)

 

NC

 

 

135BJ5

 

4A Dual Mode (Off-Board)

 

$310.00

 

 

 

 

 

 

 

 

Battery Straps

 

 

 

 

 

 

135BK6

 

Battery Straps w/insert (U1 & 40Ahr)

 

NC

* K0011 when supplied with seat and necessary components

FOOTNOTES:

1Two single switches required to operate both the on/off and mode select functions.

2Not available with Integral Joystick.

3VSI controller is a 50A with a 20A boost.

4Dual Toggle not available with Power Legrests

5Requires Qtronix Remote Joystick

6Comfort Seat and Fixed Rehab Seat Sizes Listed on Freestyle Price List 931170

7No Charge if Thru Drive 1 Power Seat Opt is Selected

8Power Recline not available with user weight above 250lbs.

PROPER USE OF HCPCS CODES DOES NOT ENSURE COVERAGE OR PAYMENT. FOR COVERAGE INFORMATION , VERIFY THE APPROPRIATE PAYER’S COVERAGE POLICY.

Specifications are subject to change without notice. Copyright @ 2005, Sunrise Medical. (11.05) Quickie Freestyle M11 - 931508 Rev G. Page 1 of 4

Quickie M11 with Perfect Fit, November 2005

SEATING-Perfect FitTM Power Seating System

ADJUSTABLE INTEGRATED SEATING

 

 

135CU1

2" Cushion

$95.00

 

 

Seat Width Range - Small - Adjustable 12" to 17"

 

 

135S3

12"

NC

 

 

135S4

13"

NC

 

 

 

 

 

 

135S5

14"

NC

 

 

 

 

 

 

135S6

15"

NC

 

 

 

 

 

 

135S7

16"

NC

 

 

 

 

 

 

135S8

17"

NC

 

 

 

 

Seat Width Range - Regular - Adjustable 15" to 20"

 

 

135S6

15"

NC

 

 

 

 

135S7

16"

NC

 

 

 

 

 

 

135S8

17"

NC

 

 

 

 

 

 

135S9

18"

NC

 

 

 

 

 

 

135S10

19"

NC

 

 

 

 

 

 

135S11

20"

NC

 

 

 

 

Seat Depth

 

 

 

 

135SD5

12"

NC

 

 

 

 

 

 

135SD6

13"

NC

 

 

 

 

 

 

135SD7

14"

NC

 

 

 

 

 

 

135SD8

15"

NC

 

 

 

 

 

 

135SD9

16"

NC

 

 

 

 

ADJUSTABLE INTEGRATED BACK

Back

 

 

135BT72

E2613 Contour Posterior Positioning Back

$

475.00

Options for Back

 

 

 

 

 

135KZ2

E1225 Manual Recline to 40°

$

175.00

 

 

135PH7

Bolt-On Attendant Push Handles

$

100.00

Back Width - Small - Adjustable 12"-13"

 

 

 

 

135BN1

12" (Only w/ Shortest Back Ht)

 

$100.00

 

 

 

 

 

 

 

 

135BN2

13" (Only w/ Shortest Back Ht)

 

$100.00

 

 

 

 

 

 

Back Width - Regular - 14"-19"

 

 

 

 

135BN3

14"

 

NC

 

 

135BN4

15"

 

NC

 

 

 

 

 

 

 

 

135BN5

16"

 

NC

 

 

 

 

 

 

 

 

135BN6

17"

 

NC

 

 

 

 

 

 

 

 

135BN7

18"

 

NC

 

 

 

 

 

 

 

 

135BN8

19"

 

NC

 

 

 

 

 

 

Back Width - Large - 17"-20"

 

 

 

 

135BN6

17"

 

NC

 

 

135BN7

18"

 

NC

 

 

 

 

 

 

 

 

135BN8

19"

 

NC

 

 

 

 

 

 

 

 

135BN9

20" (Not Available on Power Recline)

 

NC

 

 

 

 

 

 

Back Height (Measured from Top of Seat Pan to Top of Back) 1

 

 

135SD10

17"

NC

 

 

 

 

135SD11

18"

NC

 

 

 

 

Back Recess 2

 

 

 

 

135OF1

0"

 

 

 

135OF2

1"

 

 

 

135OF3

2"

 

 

 

135OF4

3"

 

 

 

 

3

 

135AY2 16" 6 135AY4 17" 6 135AY6 18"

135AY8 19" 135AY10 20" 135AY12 21" 135AY13 22"

135AY15 23"

135AY17 24"

135AY19 25"

135AY21 26"

135AY24 27"

135AY23 28"

 

 

135OF5

4"

 

 

 

 

 

 

 

 

Seat Height (at 0 degrees)

 

 

 

135HT8

17"9

NC

 

 

 

 

 

 

135HT10

18"8

NC

 

 

 

 

135HT12

19"8

NC

 

 

 

 

 

 

135HT14

20"9

NC

 

 

Pre-Set Seat Frame Angle

 

 

 

135FA10

0o

NC

 

 

 

 

 

 

135FA3

3o

NC

 

 

 

 

135FA4

6o (Not available with power seating)

NC

 

 

 

 

 

 

135FA5

9o (Not available with power seating)

NC

 

 

FOOTNOTES:

1There is a minimum gap of between the seat pan and the bottom of the back to allow for recline. It is between .5" and 3.5" on the manual back and 2.5" to 4" on the power recline with shear reduction.

2"Recess", moves seatpan forward relative to back.

34" Recess only available with 12", 15", and 18" seat depths

4Not available on Reclining Height Adjustable Armrest.

5To be used with Otto Bock Forearm Pads.

6Not available with Power Recline

7Not available with Manual Adjustable Back

8Add 1/2" for Power Tilt and Power Recline Combination

9 Not Available with Power Tilt

ARMRESTS (pr)

Armrest (NC on Perfect Fit Power CG Tilt or Power Recline)

 

 

 

135AA70

E0973

PF Flip Back Ht Adj.(7"-14") 6

 

$250.00

 

 

 

Reclining Height Adjustable7

 

 

 

 

 

 

135AA60

E0973

Std Height (10.8" - 14")

 

 

$250.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135AA61

E0973

Tall Height (12.8" - 16")

 

 

$250.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135AA14

 

Omit Armrests

 

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135SG17

 

Removable Sideguards

 

 

$120.00

Armpads (pr)

 

 

 

 

 

 

 

 

135AE01

 

Desk Length Waterfall (10")

 

4

NC

 

 

 

 

 

 

 

 

 

135AE02

 

Full Length Waterfall (14")

4

 

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135AE03

 

Desk Length Standard (10") 4

 

$15.00

 

 

 

 

 

 

 

 

 

 

 

 

 

135AE04

 

Full Length Standard (14") 4

 

 

$15.00

 

 

 

 

 

 

 

 

 

135AE05

 

Reclining Arm Pad (16") 7

 

 

NC

 

 

 

 

 

 

 

 

135AE09

 

Omit Arm Pad

 

 

NC

 

 

 

 

 

 

Otto Bock Armpad Options

 

 

 

 

 

 

135AE08

K0106

Otto Bock Sm forearms pads (8")

$240.00

 

 

 

 

 

 

 

 

 

135AE06

K0106

Otto Bock Med forearms pads (11.5")

$240.00

 

 

 

135AE07

K0106

Otto Bock Lg forearms pads (14")

$240.00

Otto Bock Hand Pads 5

(pr)

 

 

 

 

 

 

135OL01

 

Medium Flat Hand Pads (4-1/2" x 7")

$105.00

 

 

 

135OL02

 

Large Flat Hand Pads (5-1/2" x 9")

$105.00

 

 

 

 

 

 

 

 

Specifications are subject to change without notice. Copyright @ 2005, Sunrise Medical. (11.05) Quickie Freestyle M11 - 931508 Rev G. Page 2 of 4

Quickie M11 with Perfect Fit, November 2005

SEATING-Perfect FitTM Power Seating System (Continued)

FOOTRESTS

Hanger

 

 

 

 

135H2

 

70° Swing Away (A,B,C)

NC

 

 

 

 

 

 

 

 

 

135H54

 

Fixed Center Mount (Inc. Footplate)1,11

$250.00

 

 

 

 

135H55

E0990

Manual Elevating SA (A,B,D)

$270.00

 

 

 

 

135H56

E1010

Powered Elevating System 2,7,12(B)

$1,440.00

 

 

 

 

135H57

E1010

Powered ELR/ALR System 2,7,12(B)

$1,880.00

 

 

 

 

135H32

 

Omit Hangers

-$20.00

Extension Tube 3

 

 

 

 

 

 

135E1

 

Short (13" - 15")

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135E2

 

Medium (15" - 18")

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135E5

 

Long (18" - 20")

NC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135E33

 

Power Artic. ELR Med (15-1/2" to 18") 4

NC

 

 

 

 

135E34

 

Power Artic. ELR Long (17-1/2" to 20") 4

NC

Foot Plate (pr)

 

 

 

 

 

 

 

135F1

Composite w/Heel Loop

NC

 

A

 

 

 

 

 

 

 

135F3

Adult Angle Adjustable w/Heel Loop (pr)

$210.00

 

B

K0040

Angle Adjustable Footplate

$165.00

 

E0951

Heel Loop

$45.00

 

 

 

 

 

 

 

 

 

135F9

Kids Angle Adjustable w/Leg Strap (pr)

$195.00

 

C

K0040

Angle Adjustable Footplate

$165.00

 

K0038

Leg Strap

$30.00

 

 

 

 

 

 

 

 

 

135F5

Aluminum

$30.00

 

D

 

 

 

 

 

 

 

135F6

 

Omit Foot Plate

-$15.00

Footrest Accessories

 

 

 

 

 

 

135A54

K0038

Extra Leg Strap, Black

$30.00

 

 

 

 

 

 

 

 

 

 

 

 

135A110

E0952

Toe Loop 3

$45.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POSITIONING OPTIONS

 

Headrest (Included on Specialty Controls)

 

 

 

 

 

135HE1

Headrest 8" x 4.5"

$450.00

 

 

 

 

 

 

 

 

 

 

 

 

 

E0955

Curved Headrest 8" x 4.5"

$225.00

 

 

 

 

 

E1028

Removable Mount

$225.00

 

 

 

 

135HE2

Headrest 9" x 4.5"

$450.00

 

 

 

 

 

 

 

 

 

 

 

 

 

E0955

Curved Headrest 9" x 4.5"

$225.00

 

 

 

 

 

E1028

Removable Mount

$225.00

Traditional Thoracic Lateral Supports

 

 

 

 

 

135ZU03

 

Fixed Mounting Hardware

NC

 

 

 

 

135ZU04

E1028

Integrated Swing Away Mount

$220.00

 

 

 

 

 

 

 

 

Traditional Lateral Pads-Curved

 

 

 

 

 

135KD5

E0956

Medium 5" x 5" (PR)

$220.00

 

 

 

 

 

 

 

 

 

 

 

 

135KD7

E0956

Large 6" x 6" (PR)

$220.00

 

 

 

 

 

 

 

 

 

 

 

 

 

Wrap-Around Swing-Away Thoracic Laterals (Pair)

 

 

 

 

 

135ZU05

E1028

Wrap-Around S/A Mount

$250.00

 

 

 

 

 

 

 

 

 

 

 

 

135ZU06

E1028

Wrap-Around S/A 2" Offset

$260.00

 

 

 

 

 

 

 

 

 

 

 

 

135ZU07

E1028

Wrap-Around S/A 3" Offset

$260.00

 

 

 

 

 

 

 

 

Wrap-Around Lateral Pads-Flat

 

 

 

 

 

135KD6

E0956

Small 4" x 4" (PR)

$200.00

 

 

 

 

 

 

 

 

 

 

 

 

135KD5

E0956

Medium 5" x 5" (PR)

$200.00

 

 

 

 

 

 

 

 

 

 

 

 

135KD7

E0956

Large 6" x 6" (PR)

$200.00

 

 

 

 

 

 

 

 

Lateral Swing-Away Knee Adductors 5,6

 

 

 

 

 

135KT01

E1028

Swing Away Mount 2" Offset (PR)

$240.00

 

 

 

 

 

 

 

 

 

 

 

 

135KT02

E1028

Swing Away Mount 4" Offset (PR)

$240.00

Knee Adductor Pads

 

 

135KS01

 

 

Small 4" x 4" (PR)

 

$200.00

 

 

135KS02

 

 

Med 5" x 5" (PR)

 

$200.00

 

 

135KS03

 

 

Large 6" x 6" (PR)

 

$200.00

 

 

 

 

 

ACCESSORIES

 

 

Backpack

 

 

 

 

 

 

 

135A1

 

 

Black Utility

 

$55.00

 

 

135A2

 

 

Black/Charcoal Kids

 

$50.00

 

 

135RB1

 

 

Readi-Align Caster Set of 2

$75.00

Auxiliary Control

 

 

 

 

 

 

 

135A42

E2351

Auxiliary Control Module

8

$795.00

 

 

 

 

 

135A44

 

 

4-1/8" Mono Plug Cable

 

$60.00

 

 

135A43

 

 

9 Pin Output Cable

 

$60.00

Attendant Control

 

 

 

 

 

 

 

135A450

E2331

Attendant Drive Control

9

$795.00

 

 

 

Positioning Belt (Seat Frames Only)

 

 

 

 

135A155

E0978

Auto Style Buckle

 

$50.00

 

 

135A12

E0978

Belt 2" Aircraft Buckle

 

$85.00

 

 

135A13

E0978

Belt 2" Aircraft Buckle Padded

$115.00

Wheelchair Tray Table

10

 

 

 

 

 

 

 

 

 

135A31

E0950

Medium Tuffak (15"-17")

 

$225.00

 

 

135A32

E0950

Large Tuffak (18"-20")

 

$225.00

 

 

135A33

E0950

X-Large Tuffak (21"-22")

 

$225.00

Programmer

 

 

 

 

 

 

 

135PR1

 

 

Qtronix Programmer Pad

 

$525.00

 

 

 

 

 

 

 

 

 

 

FOOTNOTES:

1This center mount is attached to seat frame as opposed to base.

2Order with Power ELR/ALR extension tubes.

3Only available with adult angle adjustable footplates.

4Only available with SA Power ELRs and Power ELR/ALRs

5Not available with 12, 13 or 14 wide seats.

6Only available with Fixed Center Mount Footrest.

7No Charge for Angle Adjustable footplate included

8Requires USCM

9Mount Available for Seat Frames Only. Not available with Integral Controller.

Operates drive only, no power seat options.

10Requires Standard Armpads. Not available with the Reclining Height Adjustable Armrest.

11Leg Length 13"-18".

12Requires Qtronix Remote Joystick

QUICKIE FREESTYLE M11 w/ PERFECT FIT SPECIFICATIONS

Maximum rider weight 300 lbs

Chair Weight: 139.9 lbs. Without batteries and footplate

User Weight: Maximum 300 lbs.

Width: 22.5"

Length: 32" (without Footplate) 38.5" (with Footplate)

Range: Up to 20 miles. Top Speed: Up to 5.5 mph

Casters: 6"

Order Form Measurments: Dimensions ±.5"

Weights ±10%

Degrees ±3°

Specifications are subject to change without notice. Copyright @ 2005, Sunrise Medical. (11.05) Quickie Freestyle M11 - 931508 Rev G. Page 3 of 4

Quickie M11 with Perfect Fit, November 2005

SEATING-Perfect FitTM Power Seating System (Continued)

SPECIALTY INPUT INDIVIDUAL COMPONENTS

Specialty Input Interface

 

 

 

 

 

Qtronix-USCM (Interface & Display Module)

 

 

 

 

135AI2

 

USCM Left, Swing Away Mount

 

$1,490.00

 

 

135AI1

 

USCM Right, Swing Away Mount

$1,490.00

 

 

135AI4

 

USCM & Omit Mount

 

$1,470.00

Specialty Input Device

 

 

 

 

 

Requires USCM

 

 

 

 

 

135ID6

 

CA-5 Interface Box

 

$150.00

 

 

 

 

 

 

 

 

 

 

135ID9

 

Mini Proportional Joystick 1

 

$780.00

 

 

 

 

 

 

 

 

 

 

135ID10

 

Penta Switch

 

$200.00

 

 

 

 

 

 

Single Switch

 

 

 

 

 

135SW1

 

Buddy Button Switch

 

$55.00

 

 

135SW2

 

Disc Switch

 

$120.00

 

 

 

 

 

 

 

 

 

 

135SW10

 

Egg Switch-Black

 

$95.00

 

 

 

 

 

 

 

 

 

 

135SW4

 

Micro Light Switch

 

$75.00

 

 

 

 

 

 

 

 

 

 

135SW6

 

Ribbon Switch

 

$45.00

 

 

 

 

 

 

 

 

 

 

135SW9

 

Wobble Switch

 

$200.00

Specialty Input Accessories

 

 

 

 

135SA01

 

Drive Input Device Switch Box

2

$750.00

 

 

 

 

 

 

 

 

 

135SA04

E2320

Remote Joystick w/Jacks - Swing Away

$985.00

 

 

 

 

(For Use with Drive Input Switch Box)

 

 

 

135SA03

E2320

Remote Joystick w/Jacks - Fixed Mount

$965.00

 

 

 

 

(For Use with Drive Input Switch Box)

 

Packages Include:

-Universal Specialty Control Module (USCM)

-Model/Reset Switch

-All Necessary Mounting Hardware

-Input Device

USCM Hand Mount

135UH2

Left Side

NC

135UH1

Right Side

NC

Packages

135ID26

Sip-N-Puff Package 1,3

 

$2,795.00

 

E2325

Sip-N-Puff Kit

 

$1,870.00

 

E0995

Headrest

 

$265.00

 

E1028

Headrest removable Mount

 

$210.00

 

E2326

Sip-N-Puff Breath Tube

 

$450.00

135ID31 ASL Head Array Package - Adult

1,3

$5,795.00

 

 

E2330

ASL Proximity Head Array

 

$5,585.00

 

E1028

Head Array Removable Mounting Hdwr

$210.00

135ID30

ASL Head Array Package - Pediatric 1,3

$5,795.00

 

E2330

ASL Proximity Head Array

 

$5,585.00

 

E1028

Head Array Removable Mounting Hdwr

$210.00

135ID13 Switch It Head Array Package - Adult 3

$4,390.00

 

E2330

Switch It Proximity Head Array

 

$4,180.00

 

E1028

Head Array Removable Mounting Hdwr

$210.00

135ID14

Switch It Head Array Package - Pediatric 3

$4,390.00

 

E2330

Switch It Proximity Head Array

 

$4,180.00

 

E1028

Head Array Removable Mounting Hdwr

$210.00

135ID28 HMC Mini Joystick Chin/Lip Control Pckg 1

$4,595.00

 

E2320

HMC Mini Joystick

 

$4,120.00

 

E0995

Headrest

 

$265.00

 

E1028

Headrest Removable Mount

 

$210.00

135ID32 HMC Mini Joystick w/Midline Gatlin Pckg 1

$4,595.00

 

E2320

 

 

$4,385.00

 

E1028

Swing Away Mount

 

$210.00

135ID33 Penta Switch Package 1

 

$1,195.00

 

E2322

(No Mount for Penta)

 

 

135ID12

Proportional Head Control Package 1,3

$3,795.00

 

E2327

Proportional Head Control

 

$3,585.00

 

E1028

Removable Mount

 

$210.00

FOOTNOTES

1Single switch required for mode/stop switch.

2Allows use of a remote and a specialty input device alternatively.

3Solid Backrest must be selected.

Sunrise Medical

7477 E. Dry Creek Pkwy Longmont, CO 80503 (800) 333-4000

Specifications are subject to change without notice. Copyright @ 2005, Sunrise Medical. (11.05) Quickie Freestyle M11 - 931508 Rev G. Page 4 of 4