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Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA 18643 Sales: Phone: (800) 800-8586 • Fax: (800) 800-1636
Account Number: Provider Name: Contact: Phone: Fax: Date: PO#: Marked For:
®
Victory 10 3-4 Wheel Scooters Order Form / Price List
Ship To: Address: City: State: Zip: Terms: Freight: Taken By:
Victory 10 shown above in Red
This product is available for purchase online at www.prideprovider.com
BASE & COLOR SELECTION
MSRP
Victory 10 3-wheel Candy Apple Red (SC610) $2,385 Victory 10 4-wheel Candy Apple Red (SC710) $2,535 Victory 10 3-wheel Viper Blue (SC610) $2,385 Victory 10 4-wheel Viper Blue (SC710) $2,535 Coded: K0801 Heavy Duty / Group 1
DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered as legal advice.
SEATING SELECTION
1
MSRP
Foldable molded plastic seat, N/C (black vinyl only) 18” W x 17” D w/ sliders
ACCESSORIES
MSRP
Cup Holder $20 Rear View Mirror $20 Lap Belt, 50” NC Lap Belt, 60” $38 Lap Belt, 70” $38 Safety Flag $32 Saddle Bag, Arm Mount (12.5” X 9.875”) $28 Oxygen Tank Holder $88 Walker Holder $88 Rear Basket, Large Square $70 In Car Charger (2-amp) 4 $125
High Back CRS $300 REAR MOUNTCANE / CRUTCH Std dimensions (18”W x 18”D) HOLDERS (acc. brkt) MSRP High Back Deluxe Contour $600 Single Rear Mount 2” $60 18”W x 20”D 20”W x 20”D Single Rear Mount 3” $60 Double Rear Mount 2” $60 Seat Color Black Vinyl Double Rear Mount 3” $60
HINGE MOUNT CANE/CRUTCH HOLDERS
Special Measurement Seat
W x D Seat sizes can not exceed 20 W x 20 D Contact your AE for pricing. Black Vinyl
BATTERIES (2 REQUIRED)
MSRP
U-1, Installed N/C (Will include a 3 amp off-board charger)
MSRP
Single Rear Mount 2” $60 Left Right Single Rear Mount 3” $60 Left Right Double Rear Mount 2” $60 Left Right Double Rear Mount 3” $60 Left Right
OTHER CANE & / OR CRUTCH HOLDERS
MSRP $40 $20
WEATHER BREAKER CANOPY - MSRP Weather Breaker3 $240 Red Blue Gray
WEATHER COVERS
MSRP
3-wheel, Medium, Black $158 4-wheel, Large, Black $202
Pride Premium Delivery Part # PREM2001 $205- Please call for details
Pride Platinum Delivery Part # PLAT1001 $260- Please call for details
1. Medium & high-back seating are not available with sliders. 2. Not available on 3-wheel version. 3. Not compatible with standard foldable molded plastic seat. 4. The In-Car charger is not intended to fully charge a depleted battery. The charger can only be used with units that have an XLR type charging port.
MSRP
Wishbone Crutch Holder $88 Quad Cane Holder $88 Forearm Crutch Holder, Clips $88 Double Crutch Holder, Clips, ( Non-hgt Adj Armrest mount) $88 Cane Clip attachment $8 (pair, armrest mount)
Revised: January 7, 2013
TOUCH-UP PAINT Candy Apple Red Viper Blue
The information contained herein is correct at the time of publication; we reserve the right to alter specifications and pricing without prior notice. US_VICTORY_10_ORDER_FORM_01-07-13
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