This form is designed to be filled out using Adobe Acrobat. 5720 Arville St. Suite 105 • Las Vegas, Nevada • Ph: 907-529-8833 • Fax: 702-754-0889 Mg Order Form Update- 119 Shipping Information Shipping Phone: Shipping Notes: Frame Style Lasher Sport Mg 00MG Magnesium frame, fixed axle wheelchair Frame Dimensions Seat Width Seat Width Taper Measurement from outside of seat tubes at rear of seat upholstery. 00SWT Measurement from outside seat tubes at front of seat upholstery. 1” (2.5cm) Taper from rear seat width to front seat width +$295 00SWT-1 Rear and Front Seat Widths- 2” (5.0cm) Taper from rear seat width to front seat width +$295 00SWT-2 Rear and Front Seat Widths- Frame Depth Seat Depth Measurement from front of backrest post to front edge of seat sling. 00FD Depth measurement in front of seat upholstery at knee bend. Standard Length Ergonomic Seat 00ES Measurement from front of backrest post to center of upward bend. None- No Ergonomic Seat 4” (10.2cm) +$495 Axle Brace Style 00ABS Style of Axle to Seat Connector

Frame Dimensions Continued Front Seat Height Rear Seat Height Measurement from floor to top of front seat rail. Measurement from floor to top of rear seat rail. Front End Angle The angle from the floor to the down tube. 95° Wheel Camber Wheel Camber is set at 2° Rear Axle Center of Gravity ** This model has a fixed (non-adjustable) axle. Measurement from front of backrest post to center of axle. 1.0” (2.5cm) 1.5” (3.8cm) 2.0” (5.0cm) 2.5” (6.4cm) 3.0” (7.6cm) 3.5” (8.9cm) 4.0” (10.2cm) 4.5” (11.4cm) Rear Wheel Offset Measure from outside of backrest post to inside of tire. (Gap between wheel...

Frame Dimensions Continued Back Height Back Angle Measurement from rear seat base to top of back. The angle from the floor to the back rest tube. Chair Options and Accessories Footrest Style Open Loop Tube Open Loop Double Tube- +$125 Angle Adjustable Aluminum- $295 * Black Only Carbon with Adjustable Width Flared Sides- +$595 Footrest Finish Satin Finish Powder Coat Frame Color- +$165 02FF03 Front Caster Forks Custom Color Anodized- +$295 Unitine, Aluminum Silver Powder Coat Frame Color- +$150 03CF03 Frog Legs Phase One (Ultra Sport), Aluminum- +$350 Silver Custom Color Anodized- +$295 03CF04...

Chair Options and Accessories- continued Rear Wheels Rear wheel size * Rear wheel size is required even if no wheel option is chosen. Chair will be built to the wheel size selected. Rear wheel model Omit rear wheels- BYOW (Bring your own wheels) List wheel model, size, and tire you will be using with your chair05RW-OMIT Sun Zero G Wheel, black spokes, black hub- No Charge 05RW-SZG Spinergy Wire Wheel, silver spokes, black hub, 30 spokes- +$320 05RW-SWW Spinergy Spox, black spokes, silver hub, 18 spokes- +$695 05RW-SS For the wheel models below, please make spoke color choice below right Spinergy...

Chair Options and Accessories- continued Wheel Locks Omit Wheel Locks Side Guards Compact Composite Scissor Locks- +$295 09SG * Aluminum Side guards will be finished with the same finish and color as the main frame. Mounting Style- Folding, non-locking Fixed (welded), non-folding- +$295 Backbar Style Mounting Style- Backrest Style Carbon w/ fender, bolted- +$695 Mounting Style- Rounded ‘Sport’ Back Bar- +$225 Back Upholstery Fabric Back (choose one) Tension Cord Rigid Back ADI Carbon Height (choose one)- Padding Style (choose one)- Original- Nylon cloth over foam Sport- Spacer Fabric over Neoprene...

Frame Finish- Color Options Powder Coat- Standard Finish- Included Powder Coat- Premium Finish- +$495 * Powder coat is a baked on finish. * Colors and shades can look different than the samples below. * Powder coat is a baked on finish. * Colors and shades can look different than the samples below. Gloss White Sunshine Yellow Rose Gold Ultra Illusion Green Heritage Cream Honda Yellow Illusion True Copper Illusion Tropical Satin Titanium Neon Yellow Light Shattered Glass Pastel Blue Heavy Silver Energy Green Illusion Malbec Illusion Pacific Galaxy Silver Racer Green Oxblood Ransom Aurora Blue...