Solutions for Daily Living order form fax to (310) 305-1718 or call (800) 454-6612 for questions Dealer: Date: Phone: Account #: Ordered By: E-mail: _ Measure User model number Product Weight (w/ trunk & hip supports) Min. Weight Capacity Max. Weight Capacity Max. Height Capacity Shoulder Harness Heights* Back Height Seat Depth (w/extension) Inside Seat Width at Front (w/extension) Inside Seat Width at Back Overall Width Shoulder Width Seat to Back Angle * Minimum Shoulder Height is 10” Car Seat Base Unit Swing-Away Trunk Supports: Refer with the trunk width ranges outlined (Pads sold separately) □ SPIRIT-TS-S to user's trunk width and compare below. Prices are per unit. Roadster Go Kart Trunk Width Range: 6” to 12” (2” x 4” Brackets) Qty_ Trunk Width Range: 10” to 14” (2” x 3” Brackets) Qty Trunk Width Range: 12” to 15” (2” x 2”; 2” x 3”) Qty Trunk Width Range: 14” to 16” (2” x 2” Brackets) Qty Tether Strap Assembly (Required Accessory) Trunk Pad size. Prices are per unit. □ SPIRIT-TP-S Optional Accessories □ SPIRIT-EX 4” Extender Extends seat depth to 16” if 3 is > 12” □ SPIRIT-AB Abductor $404 For mounting directly on SPIRIT □ SPIRIT-AB-4 Abductor for use with extender $404 For mounting on SPIRIT-EX SPIRIT-TP-M SPIRIT-TP-L BUCGRD Retainer Clip Guard Swing-Away Hip Supports: Refer to user's hip width [Sand compare with the hip width ranges outlined below. Prices are per unit. (Pads sold separately) □ SPIRIT-HS-S Hip Width Range: 10” to 14” $275 (2” x 3” Brackets) Qty □ SPIRIT-HS-M Hip Width Range: 13” to 16” $275 Hip Pad size. Prices are per unit. □ SPIRIT-HP-S Pad, S (3” x 6”) Qty_ For vehicle manufactured before 2002 Incontinence Cover □ SPIRIT-IC Car Seat Cover □ SPIRIT-IC-HP-S Hip Pad Covers, S □ SPIRIT-IC-HP-M Hip Pad Covers, M □ SPIRIT-IC-HP-L Hip Pad Covers, L □ SPIRIT-IC-AB Abductor Cover Viscoelastic (Memory Foam) Padding for Seat & Back 3” Extensor Thrust Wedge Prices listed are retail and are subject to change without notice. © 2016