ORDER FORM

Date

Order number / referenceCompany

Street

E-Mail

Company

City, Zip code

Telephone

INVOICE ADRESS

DELIVERY ADRESSOrder

Customer reference

Street City, Zip code

PRODUCT DESCRIPTION SIZE / ORDER CODES

FRAME

FABRICCOLOUR

O�er

1 of 3

• Sizes 1 to 4 years of age (same cushioning and equipment)• Stable postural support• Comfortable growability• Precise pelvic and thoracic positioning• Adjustable abduction components• Ultra lightweight• Machine washable cushioning• Practical high-low chassis base• Compatible with stroller and wheelchair interfaces• Available colours: Blue & Red

White Anthracite

RED RED

BLUEBLUE

SEATING SYSTEM

Supports:Backrest Height:Headrest Size:Footrest Adjustment:Footrest Size:Tray Size:Seat Width:Seat Depth:Height-Ground Interface:

7’’ to 10’’12’’ to 14 1/2’’7’’ x 4’’7’’ to 8 1/2’’ (1-2 yrs) / 7’’ to 9 1/2’’ (3-4 yrs)10’’ x 5’’ (1-2 yrs) / 11’’ x 8’’ (3-4 yrs)18’’ x 18’’7’’ to 9’’7 1/2’’ to 9 1/2’’19 1/2’’ to 9 1/2’’

3 718 CAD$SEGO SEAT / 008 - 10501(Size 1)

136 CAD$

ON DEMAND

INCLUDED

INCLUDED

ON DEMAND

ON DEMAND

2 of 3

HEADREST

NO. Desc. / Codes

POSITIONING AND FIXATION

Accessories

INCLUDED

318 CAD$

182 CAD$

182 CAD$

182 CAD$

ON DEMAND

A1

A2

A3

PELVIS / ABDUCTION

C1

C2

C3

C4

C5

Headrest STD SEGO / 008 -10503

Headrest with hinged lateral / 022 -201

A4

A5

A6

Headrest STD malleable / 022 -202

Headrest rigid density / 022 -150

Headrest soft density / 022 -155

Custom headrest / 022 -204

TRUNK

NO. Desc. / Codes

93 CAD$

93 CAD$

93 CAD$

INCLUDED

B1

B2

B3

Harness 4 point STD SEGO / 008 -105 -149

X Style Harness 4 point (no zipper) / 061 -C314

B4

X Style Harness 4 point (with zipper) / 061 -C315

2 point belt STD SEGO / 008-105-150

Abduction support (pair) / 008-10511

C6

Pelvic support - LEFT / 008-105-069

Modi�ed seat / 008-105-191

XXS

STD

STD

STD

STD

STD

STD

STD

STD

XS

L

S

XXS XS S

S

STD

Pelvic support - RIGHT / 008-105-068

Pelvic support modi�ed - RIGHT / 008-105-068MOB

Pelvic support modi�ed - LEFT / 008-105-069MOB

STD

S - smallXS - extra small

M - mediumL - largeXL - extra large

Sizes:

Telephone +1 450 752.8818

Toll free +1 888 752.8818

1242 De LanaudièreJoliette, Québec J6E 3P1synetikgroup.com

3 of 3

L 336 CAD$

218 CAD$

218 CAD$

335 CAD$

73 CAD$

INCLUDED

INCLUDED

LEGS / ARMS

D1

D2

D3

D4

D5

Footrest SEGO / 008-10508

D6

Sandals (pair) / 140- 921

Sandals (pair) / 140- 920

S

S

L

D7

D8

Tray SEGO / 008-10506

Padded tray insert (black) / 008-10517

Armrest SEGO - LEFT / 008-10504

Armrest SEGO - RIGHT / 008-10505

STD

STD

STD

STD

96 CAD$Elbow bloc SEGO (pair) / 008-105 -194 STD

364 CAD$

191 CAD$

1 455 CAD$

1 455 CAD$

3 640 CAD$

3 640 CAD$

PROTECTION / TRANSPORT

E1

E3

E4

E5

Canopy SEGO (black) / 008-105 -195

Interface SEGO Seat/TOM 5 stroller (black)008-10507

Hi/low base White / 008-10502 -PBLA

E6 TOM 5 frame-STD - Anthracite / 010- 008 -01 -AT

Hi/low base Anthracite / 008-10502 -PANT

STD

STD

STD

STD

E7 TOM 5 fram-MAXI - Anthracite / 010- 008 -02 -AT