Transcript
Synthesis Transport Chair PO:
Model: V4 WC19
Date:
US MSRP Order Form March 2017
Customer #:
Customer Name: Address:
Ship To Name: Address:
Phone: Contact: Email:
Phone: Contact: Tag:
Standard Features
*Shown with Optional Magwheel
• Comfort Tension Seating® • Removable Height and Width Adjustable Upper Laterals (Wings) • Up to 40° Infinitely Adjustable Seat Tilt • Up to 90° Infinitely Adjustable Back Recline • Trendelenburg Capable • Height Adjustable, Swing Away Removable Arms • Elevating and Articulating Legrest • 2 x 5" Total Lock Front Casters • 2 x 6" Rear Multi-Directional Locking Casters • 350lb Weight Capacity
Synthesis Transport Chair - Model: V4 WC19 MSRP $4,144 (WC19 Compliant Transit Tie Down Vehicle Transport Package - Factory Installed Only) Seat Width:
Seat Height:
⃝ 16" ⃝ 18" ⃝ 20" ⃝ 22" ⃝ 24" 20.5" Front Options
⃝ 5" Total Lock Front Casters ⃝ 5" Aluminum Non-Locking Front Casters (available with rear mags only)
⃝ 5" Front Locking Twin Wheel Casters
Seat and Back Options N/C Seat Depth: $418 $946 Back Height: Standard
⃝ 17" ⃝ 18.5" ⃝ 32" ⃝ 33.5" ⃝ 35"
Wheel Options Rear Options ⃝ 6" Multi-Directional Locking Rear Casters Standard ⃝ 14" Rear Mags $190 ⃝ 20" Rear Mags ⃝ Wheel Lock Extension Handles (pair) $190 Elevating Footrest Options (Select one)
⃝ Adjustable Elevating Split Footrest (not available in 16" seat width) (Choose number of straps) ⃝ 2 ⃝ 3 ⃝ 4 ⃝ 5 ⃝ Adjustable Elevating Single Footrest (Choose number of straps) ⃝ 2 ⃝ 3 ⃝ 4 ⃝ 5 Armrest Options ⃝ Soft Armrest Armrest Standard Armtop Style: Height Adjustable Arms Seat Mounted Arms ⃝ Long Armrest Options: $42 Armtop ⃝ Padded Armrests (pair)(black) $80 Mount: Base Frame Finish Color (Select one) ⃝ Carmine Red ⃝ Ocean Blue ⃝ Midnight Black ⃝ Satin Nickel ⃝ Tungsten Sand ⃝ Bronze
PSOF 02-ORDER-086MAR17
Standard N/C Standard $100 $100 Standard $332 $332 $64 Standard N/C
Standard Standard
N/C N/C
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Synthesis Transport Chair
Model: V4 WC19
US MSRP Order Form March 2017
Upholstery Color Options (Select one) * Standard padding configuration: Headrest, exterior of shoulder bolsters, upper and lower side pads, sole pads come in Accent Color. Seat, back and calf pads, and interior of shoulder bolsters come standard in Savoy Black Vinyl. ** Indigo, Espresso & Graphite are available on seat, back & calf pad & most accessories. See below under padding for selection. *** In honor of our Veterans Service, Camo options are now available.
Standard Padding*: Shown with Graphite Upholstery & Accent Padding**: Shown with Indigo Upholstery & Black Carmine Red Frame Color *Shown with optional Magwheel Frame Color Upholstery Accent Color* (Select One) Vinyl: Polyurethane: ⃝ Indigo** ⃝ Interlace Espresso** ⃝ Graphite** ⃝ Portobello ⃝ Geyser ⃝ Fossil ⃝Forge Camo Nylon:*** (with performance finish) ⃝ Black ⃝ Smoke House ⃝ Chocolate ⃝ Digital Camo Green ⃝ Retro Camo Jungle $130 Padding - Choose Option 1 OR 2 ⃝ Option 1 - BRODA Padding N/C Standard BRODA Padding: Includes: In Accent Color: Headrest, Exterior Shoulder Bolsters, Upper & Lower Side Pads & Sole Pads*. In Black Vinyl: Seat & Back Pads with Covers, Calf Pad & Interior Shoulder Bolster ⃝ Black Vinyl Seat, Back & Calf Standard ⃝ Accent Color* Pad Cover Options: N/C ***(For Indigo, Espresso or Graphite only) ⃝ Full vinyl Wrap Seat & Back Pads $100 (Select Black Vinyl OR Accent Color Vinyl Above) ⃝ Calf Pad Color N/C (Select Black Vinyl OR Accent Color Vinyl Above) ⃝ Grey Terry ⃝ White Terry N/C ⃝ Includes Shoulder Bolsters - Long, Thigh Belt & Footbox Long HSP Padding Package: $544 T-Belt Color: ⃝ Black Vinyl ⃝ Accent Color Vinyl N/C Footbox Long Color: ⃝ Black Vinyl ⃝ Accent Color Vinyl N/C ⃝ Optional Elevating Fixed Footrest N/C ⃝ Option 2 - BRODA APP (Additional Positioning Package) BRODA APP Padding Package Includes: Seat Cushion, Back and Head Support, Foot & Calf Support, Upper & Lower Side Pads Seat Width: Seat Depth: ⃝ 17" ⃝ 19" ⃝ 21" ⃝ 16" ⃝ 18" ⃝ 20" $522 ⃝ 22" ⃝ 24" ⃝ 17" ⃝ 19" ⃝ 21" $628 Additional Options: Delivery Instructions or Special Requests:
PSOF 02-ORDER-086MAR17
Total: $
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