Power Wheelchair Retail Prescription Form TDXSP2HD231118 Tel: 01656 776222 Fax: 01656 776220 Email: [email protected] Online Spares available at: www.invacare.co.uk Delivery Address : Order Qty : Order Date : Standard Base Price £5,184 X * Configurations may vary from the image shown Please make your selection with a cross in the box Standard feature TDX SP2 Special Model - PLEASE COMPLETE DETAILS AT THE END OF THE FORM SEATING TYPE : MODULITE MULTI ADJUSTABLE SEATING SYSTEM ARJ2100 Modulite Seating Unit SEAT FRAME AND SEAT PLATE ARJ2111 Telescopic Seat Frame with metal seat plate (with stepless adjustment on armrests, legrests and backrest)

MODULITE SEAT SIZE SETTING CHART: Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior notice.

Long ergonomic armpad ARMRESTS (Pail) EXTENDED HEIGHT (+2") MOUNTING HARDWARE FOR HIP SUPPORTS NEW! ARJ2165 Extended height mounting hardware for hip supports (8.1" / 206mm high) O Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior notice.

Lateral multi adjustable pad 1445 LATERAL SUPPORT (Pair) SEAT POSITIONING ADJUSTMENTS SEAT LIFTER / SEAT TILT SEAT TILT OPTION (only if option 1093 or 1094 have been selected) 5° Fixed Anterior Tilt Assist mount (will reduce max tilt angle by 5°) Seat to ground height measured when in negative tilt at front seat edge BACKREST RECLINER Manual Settable Recliner (0° - 30° in 3.75° steps) Foldable Powered Recliner (0° - 30°) Foldable PLEASE CHOOSE EITHER CENTRE MOUNTED OR SIDE MOUNTED LEGRESTS Standard 80° 0526 VARI F 0503 VARI A 0533 ADM 0532 ADE 0531 MANUAL CENTRE MOUNT 0556 £375 POWERED CENTRE...

LiNX PRIMARY CONTROLS (SECTION 1) LiNX PRIMARY REMOTE & BRACKET Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior notice.

LiNX SPECIALIST CONTROLS (SECTION 2) Compact Remote 2231 Compact Remote Low Force 2232 Head Control (ATOM) Head Control (PROTON) LiNX - COMPACT REMOTES & BRACKET (Requires Primary Remote REM400) ARJ2231 Proportional Compact Remote DLX-CR400 Proportional Compact Remote Low Force DLX-CR-400LF Centre Mount swing away to RH (Nucleus) Centre Mount swing away to LH (Nucleus) Individual mounting option per request (Special) - Requires additional information / specification LiNX CHIN CONTROL & BRACKET (Requires Primary Remote REM400) ARJ2229 Proportional Chin Joystick (ASL138) Swing Away Bracket RH side...

Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior notice.

Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior notice.

Need a different option not on the form? Take a look at our Powerchair Alternative Options form, available as standard Powerchair Alternative Option required: Please refer to our Invacare Unique special order form, for more complex custom requirements. Available at www.invacare.co.uk Special Instructions - Please supply the following information: Name: Email: Phone: Fax: Description of special request (please include relevant option code or part number): Order Number: Subject to Invacares standard terms conditions. Invacare reserve the right to alter product specification without prior...