THE ORDER CANNOT BE PROCESSED WITHOUT THE FOLLOWING

HD (K0852/K0860/K0863)

MKT.F25 | OF | P17021 | Rev.02

ORDERING INFORMATION : Phone : +1 450 424-0288 | Fax : +1 450 424-7211 | [email protected] | amylior.com

Amysystems is an Inc. brand

PAGES 1 OF 12Specifications are subject to change without notice. © Amylior Inc. 2020 (February). All rights reserved

1. ACCOUNT INFORMATIONP.O. # or Quote: ________________________________________________________________________________

Dealer Contact Name:____________________________________________________________________________

Email Address: __________________________________________________________________________________

Phone Number: _________________________________ Fax Number: _________________________________

Bill to (Name): ___________________________________________________________________________________

Bill to (Location): _________________________________________________________________________________

Ship to (Name): __________________________________________________________________________________

Address: ________________________________________________________________________________________

City: ___________________________________________________________________________________________

State: ____________________________________________________ Zip Code: _________________________

User Name or Number: __________________________________________________________________________

User Weight: ___________________________________________________________________________________

User Height: ____________________________________________________________________________________

Seat Cushion Thickness: _________________________________________________________________________

Knee to Heel Length: Left: ________________________________" Right: ____________________________"

THE ORDER CANNOT BE PROCESSED WITHOUT THE FOLLOWING:- A user name or number, the client’s measurements and weight - Amylior is not responsible for configuration or size discrepancies resulting from customer errors on the order form. - Order confirmations will be provided by Amylior summarizing the items selected. Please review this carefully. - Once the order is shipped, any changes are subject to the returns policy and may be prohibited. - This product design meets and/or exceeds the code requirements

*IN RED SHOWS THE ADDITION OF NEW OPTIONS, UPGRADES, PRICING MODIFICATIONS OR ADDED NOTES

2. STANDARD OPTIONS FOR HCPCS CODES ((K0852, K0860, K0863, K0014) Alltrack HD3 Power Base, 6-wheel independent wheel suspension, an additional seat suspension system, tie-down hardware for strap systems, 8A offboard charger, 8" front casters, and stan-dard auto style buckle seat positioning strap, 5.4mph motors, Weight Capacity = 550 lb

3. ALLTRACK HD3 POWER WHEELCHAIR ATHD3-3VHD-SS ALLTRACK HD3 Power Wheelchair – (K0855 / K0014) – (Group 3 Very Heavy Duty, No Power) $11,495 ATHD3-3VHD-SP ALLTRACK HD3 Power Wheelchair – (K0860 / K0014) – (Group 3 Very Heavy Duty, Single Power) $11,495 ATHD3-3VHD-MP ALLTRACK HD3 Power Wheelchair – (K0863 / K0014) – (Group 3 Very Heavy Duty, Multiple Power) $11,495

4. USER WEIGHT PACKAGES WCA55 550 lb Maximum user weight capacity STD

5. STANDARD FRAME COLORS FCBLK Black STD FCRZB Razzleberry STD FCSBM Matte Black STD FCMYG Military Green N/C FCGMC Gun Metal (Charcoal) STD FCBOR Burnt Orange Metallic N/C FCSVM Silver Metallic STD FCBAO Black Opal Metallic N/C FCCBU Candy Blue STD FCOPM Sparkle Orange N/C FCCRE Candy Red STD FCMYT Military Tan N/C FCMPL Midnight Purple STD FCPKP Pearl Pink N/C FCMWT Matte White STD

OPTIONAL FRAME COLORS (MAY INCREASE LEAD TIMES) FCHDD Desert Digital Camo Hydro Graphics $995 FCHWL Woodland Camo Hydro Graphics $995 FCHCF CarbonfiberHydroGraphics-(Matte black base) $995

6. MATCHING ACCESSORIES TO THE FRAME COLOR FC***-M Matching Accessories to the Frame Color – (Wheels, front access door, headrest mount and back shell when selected) $295

c This options is included at no charge with the Hydro Graphics Frame Color option.

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7. TRANSPORT OPTION TTD4 4-Pointwheelchairtransportbrackets STD

c 4-Point wheelchair transport brackets have not yet received WC-19 crash-testing approval.

8. MOTOR PACKAGE MP544 5.4mph4-PoleMotorPackage– (with COG Release) STD

9. ASSISTIVE DRIVING PACKAGE SMARTT Smart-Track–(K0108) $1,495

c Smart-Track technology provides increased tracking capabilities with enhanced traction and steering precision. This is ideal for those with marginal hand function or switch control.

c Requires the R-net PM 120 Amp Expandable Controller (ECR120).

10. BATTERY CHARGER BCOB 8A Offboard Battery Charger N/C

11. BATTERY TRAY AND FRAME SIZE FS24B Battery Tray for Group 24 Batteries – (Total frame width = 27 3/8") N/C

12. BATTERIES BAT24GEL Premium CGPower-GELBattery–Group24–70Amps(Each) – (E2363) $430

13. CHOOSE TIRE COLOR (APPLIES TO ALL TIRES OR CASTERS) BLACK GREY

14. DRIVE WHEEL DW14PT 14" Cast Wheel Pneumatic Tire STD DW14PI 14" Cast Wheel Pneumatic with Foam Filled N/C DW144PT 14" x 4" Extra Wide Cast Wheel Pneumatic Tire (Requires the Black Tire Selection) $550 DW144PI 14" x 4" Extra Wide Cast Wheel Pneumatic with Foam Filled (Requires the Black Tire Selection) $550

c The 14" x 4" Extra Wide Wheel increases the overall width of the Base by 2 ½".

c The option to Match the Wheels to the Shroud Color (FC…-M) is not available with the 14" x 4" Extra Wide wheels.

c The 14" x 4" option is not available with VR2 electronics (ECV902A).

15. FRONT CASTERS FC8PTM 8" Pneumatic Casters STD FC8PIM 8" Pneumatic Casters with Foam Filled N/C

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16. SEAT TO FLOOR HEIGHT (APPROXIMATE MEASUREMENT TO THE TOP OF SEAT PAN ± ¼") f OPTIONS FOR A SEAT ONLY STFH1725 17¼"-(Possible Seat angle of 0° and 3°) STFH1925 19¼"-(Possible Seat angle of 0°, 3° and 6°)

STFH1825 18 ¼"-(Possible Seat angle of 0° and 3°) STFH2025 20¼"-(Possible Seat angle of 0°, 3°, 6° and 9°)

f OPTIONS FOR THE 45° HD POWER TILT STFH17 17"-(Possible Seat angle of 0° only) STFH185 18½"-(Possible Seat angle of 0° only)

STFH175 17½"-(Possible Seat angle of 0° only) STFH19 19"-(Possible Seat angle of 0° only) STFH18 18"-(Possible Seat angle of 0° only)

17. SEAT TO FLOOR HEIGHT SPECIFICATION (IF NOT STANDARD)

SOMHSS Specificseattofloorheightrequirementotherthanstandard– (Custom upcharges may apply) RFQ c Required at: _______________" (± ¼" Range)

18. PRE-SET SEAT FRAME ANGLE SFE-0 0oPre-setseatframeseatangle–(Must be selected when using power options) STD SFE-3 3oPre-setseatframeseatangle–(Only available with a seat configuration without power options) N/C SFE-6 6oPre-setseatframeseatangle–(Only available with a seat configuration without power options) N/C SFE-9 9oPre-setseatframeseatangle–(Only available with a seat configuration without power options) N/C

19. LIGHTING PACKAGE EOLP LED Light Package – (Includes front beams, side flashers, rear tail light with flashers & brake light) $1,345

c Requires the upgraded Joystick with Light Operation or the OMNI 2 (ECVJ6KL, ECELJL, ECRJCL, ECRJC35B or EDIB). The Light Package is not compatible with the EPSEL option.

20. NON-EXPANDABLE ELECTRONICS - PG DRIVES VR2 CONTROLLER AND JOYSTICKS f VR2 Electronics can only accommodate a single power seat function. The only choices are Power Tilt or Elevating seat.

ECV902A VR290AmpDriveController– (Requires the selection of VR2 joystick below) STD ECVJ4K VR2Standard4-KeyJoystick STD ECVJ6K VR26-KeyJoystick– (Allows for a single power option to operate through this joystick) $250 ECVJ9KL VR29-KeyJoystickwithLightingOperation– (Allows for a single power function to operate through this joystick) $350

21. EXPANDABLE ELECTRONICS - PG DRIVES RNET CONTROLLERS ECEL90 R-netEL90AmpExpandableController– (E2377) $595 ECR120 R-netPM120AmpExpandableController – (E2377) $695 ECRNH Harness for Expandable Controller – (E2313) $625

c Must be ordered with the expandable controller ECEL90 or ECR120 to interface with Joysticks or OMNI 2 screen.

22. EXPANDABLE ELECTRONICS - PG DRIVES RNET JOYSTICKS f Selection of one joystick option below is required with the expandable controller ECEL90 or ECR120

ECO OmitJoystick–(For use with an Omni 2 Display) N/C ECELJ R-net-(LED) –Joystick STD

c This Joystick is not compatible with the Memory Seat Program Option (SWMEMORY).

ECRJC R-netJoystickwithColorscreen $75 f JOYSTICKS WITH LIGHTING OPERATION ECELJL R-net–(LED) –JoystickwithLightingOperation $525

c This Joystick is not compatible with the Memory Seat Program Option (SWMEMORY).

ECRJCL R-netJoystickwithColorscreenandLightingOperation $625 f ADVANCED JOYSTICK ECRJC35B R-netAdvancedBluetoothJoystick(3.5" Screen). Lighting Operation, paddle switches, shortcut keys and stereo jacks $995

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23. JOYSTICK MOUNT JSMF FixedJoystickMount N/C JSMSA SwingAwayJoystickMount–Heightadjustable,AngleadjustableandMulti-Axis–(E1028) $375

Set-up with standard installation to swing-away sideways Set-up at 35° to swing-away sideways and downwards

JSMCM MidlineMountedSwingAwayJoystickMount–(E1028) $375

24. JOYSTICK MOUNT SUPPORT JSMFH JoystickmountsupportBracket STD

25. JOYSTICK HAND MOUNT HML InstallJoystickonLefthandside HMR InstallJoystickonRighthandside

26. JOYSTICK HANDLE JSH StandardJoystickGimble STD JBAT Stick Handle 3" in Length – (E2323) $86 JBH Ball Handle – (E2323) $86 JFBH Foam Ball Handle – (E2323) $86 JTH T-Handle–(E2323) $86 JMUSH Bodypoint Mushroom Handle (E2323) $112 JGP Bodypoint4"U-shapedHandle–(E2323) $112

27. ATTENDANT DRIVE CONTROL OPTION EADC AttendantHandControlforR-netEL&PMControls–(E2331) $895

28. ATTENDANT JOYSTICK HAND MOUNT EADCL InstallAttendantJoystickonRearLefthandside EADCR InstallAttendantJoystickonRearRighthandside

29. RNET OMNI 2 - ENHANCED DISPLAY & DIGITAL INTERFACE BOX (REQUIRED WITH SPECIALTY CONTROLS)

EDIB NEW Omni 2 – (Enhanced Display & Digital Interface Box with Infrared) $1,986 c Allows the switch operation of alternative devices through driver controls. Requires the R-net fully Expandable Controller (ECR120)

c The Omni 2 display mount must be selected from the option below.

30. OMNI 2 ENHANCED DISPLAY MOUNT EDSAM User Swing Away Mount – (E1028) $395

EDML – (Install Display on LH side) EDMR – (Install Display on RH side)

31. ENVIRONMENTAL CONTROL MODULE ECU Environment control module – (Output Module) – (E2351) $825

c Requires one of the fully expandable R-net controllers (ECEL90 or ECR120).

32. BLUETOOTH MOUSE EMULATOR

EDBT Bluetooth Mouse Emulator – (USB Dongle included) $795 c Requires one of the fully expandable R-net controllers (ECEL90 or ECR120).

Not required if the ECRJC35B joystick has been selected.

c Not limited to only one selection. Any two can be installed on the same chair, but only one can be used at a time.

Windows and MAC OS Android Devices Iphone, Ipad and Ipod

33. POWER OPTIONS & SEATING SAABAHD-550-STD Bariatric Amyseat Rehab Seat – (Seat Frame only) STD SAPTXVHD Bariatric CG Power Tilt (E1002) – (This option includes the Amyseat Rehab Seat) – (SAABAHD) $8,595 SAPRXVHD Bariatric Power Recline with Integrated Shear Reduction (ISR) – (E1004) – (This option includes the Amyseat Rehab Seat) – (SAABAHD) $9,495

c It is recommended to use the NXT Back Support option with the power or manual reclines (NOACB or NOPCB)

SAPTPRXVHD Bariatric CG Power Tilt and Power Recline with Integrated Shear Reduction (ISR) – (E1007). $13,595 c This option includes the Amyseat Rehab Seat (SAABAHD).

c It is recommended to use the NXT Back Support option with the power or manual reclines (NOACB or NOPCB)

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34. ELECTRONICS - SINGLE (1 ACTUATOR) POWER SEAT FUNCTION CONTROLLERS EPSV Tilt or Elevating seat activaton through 6-key VR2 Hand Control – (ECVJ6K or ECVJ9KL) – (E2310) $1,895 EPSEL Tilt or Elevating seat activaton through RNET 90 Amp Expandable Controller – (ECEL90) – (E2310) $1,895

c EPSV and EPSEL allows for the activation of a single power option through the VR2 or R-net 90 Amp Controllers. Only the Power Tilt or Elevating seat options are available with this feature. These options do not require the SAC controller as they connect via the chair's power module directly.

SAC Single – (1)–PowerSeatFunctionControllertoInterfacethroughR-netElectronics–(E2310) $2,895 c Includes an Integrated Single toggle switch for user activation if selecting SWSWITCH-S

SWMEMORY NEW Memory Seat Program $175 c Requires the e-bx Multiple Power Seat Function Controller (MAC)

c This option is not compatible with LED joysticks (ECELJ and ECELJL).

f PLEASE SELECT ONE (1) ACTIVATION FROM THE LIST BELOW SWTJSS SingleactuatoractivationthroughR-netJoystickorSpecialtyControls STD SWSWITCH-S Single actuator activation through the Integrated Controller Switch. N/C

c This option removes the rear electronic structure and shroud behind the backrest for all power seating options other than power recline.

SWDUALACT Dual Activation – (Allows to operate all seat functions with external switches and through the joystick) $295 c Please select an electronic switch from the list below..

f EXTERNAL SWITCHES - REQUIRED IF CHOOSING THE SWDUALACT OPTION SWTOGGLE Single Toggle Switch Attendant Activation N/C SWPUSH1 Single Push Button Switch – (Single Mode: SAC) User Activation Attendant Activation N/C SWPUSH2 Dual Push Button Switch – (Dual Mode: SAC) User Activation Attendant Activation N/C

35. ELECTRONICS - E-BX MULTIPLE POWER SEAT FUNCTION CONTROLLER MAC NEW E-BXMultiplePowerSeatFunctionControllertoInterfacethroughR-netElectronics – Powers iQ Actuators (E2311) $3,695

c The MAC option requires the R-net 90 Amp (ECEL90) or the 120 Amp (ECR120) Fully Expandable Controllers.

SWMEMORY NEW Memory Seat Program $175 c Requires the E-BX Multiple Power Seat Function Controller (MAC)

c This option is not compatible with LED joysticks (ECELJ and ECELJL)

f PLEASE SELECT ONE (1) ACTIVATION FROM THE LIST BELOW SWTJSM MultipleActuatoractivationthroughR-netJoystickorSpecialtyControls STD SWSWITCH-D Two (2) actuator activation through the Integrated Controller Switch. N/C

c Only select this option when using two actuators through switch operation only.

c This option removes the rear electronic structure and shroud behind the backrest for all power seating options other than power recline.

c The Memory function is no longer compatible (SWMEMORY) .

SWSWITCH-EBX Multiple Actuator Activation through an external Switch only N/C c Please select an external switch from the selection below

SWDUALACT-EBX Dual Activation – (Allows to operate all seat functions with external switches and through the joystick) N/C f EXTERNAL SWITCHES - REQUIRED IF CHOOSING SWSWITCH-EBX OR SWDUALACT-EBX, NOT COMPATIBLE IF CHOOSING SWSWITCH-D SWKEYPAD-T NEW Keypad w/ 5 Toggle Switches User Activation Attendant Activation $295 SWKEYPAD-P NEW Keypad w/ 5 Push Button Switches User Activation Attendant Activation N/C SWMULTI 4-WayToggleSwitch–(Up to 4 Activations) User Activation Attendant Activation N/C

c Selecting the Memory Seat option (SWMEMORY) with this Switch type requires a custom modification. .

SWMULTIT Triple Toggle Switch – (Up to 5 Activations) User Activation Attendant Activation N/C c Selecting the Memory Seat option (SWMEMORY) with this Switch type requires a custom modification. .

SWPUSH4 4-WayPushButtonSwitch User Activation Attendant Activation N/C c Selecting the Memory Seat option (SWMEMORY) with this Switch type requires a custom modification. .

SWPUSH5 5-WayPushButtonSwitch User Activation Attendant Activation N/C c Selecting the Memory Seat option (SWMEMORY) with this Switch type requires a custom modification. .

36. SWITCH ACTIVATION HAND MOUNT Switch Installation: TSML – (Install Switch on LH side) TSMR – (Install Switch on RH side) N/C

37. PRE-SET BACK ANGLE (FOR NON-RECLINING BACKS)

SOBAA For SOWN19-24-22 seat range, select one: 86° 90° 94° 98° 102° 106° 110° 114° 118° 122° N/C For SOWN24-26-22 seat range, select one: 82° 90° 98° 106° N/C

c Back angles of 102° or greater are not compatible with the OMNI 2.

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39. LARGE ADJUSTABLE SEAT WIDTH RANGE BETWEEN 19" AND 28" SOWN19-24-22 – (Width adjustment from 19" to 24" and Depth range of 18" to 22") STD SOWN24-28-24 – (Width adjustment from 24" to 28" and Depth range of 18" to 24") STD 19" (SOWN19L) 20" (SOWN20L) 21" (SOWN21) 22" (SOWN22) 23" (SOWN23) 24" (SOWN24) 24" (SOWN24HDL) 25" (SOWN25HDL) 26" (SOWN26HDL) 26" (SOWN26HDL) 27" (SOWN27HDL) 28" (SOWN28HDL)

40. ADJUSTABLE SEAT DEPTH RANGE BETWEEN 18" AND 24" 18" (SODN18) 19" (SODN19) 20" (SODN20) 21" (SODN21) 22" (SODN22) 23" (SODN23) 24" (SODN24)

41. BACK CANE HEIGHT (THE BACK CANE HEIGHT MEASUREMENT IS TAKEN FROM THE SEAT PAN TO THE TOP OF THE PUSH HANDLES)

d 22" is the minimum back cane height required with a power or manual recline.

16" (SOBCH16) 18" (SOBCH18) 20" (SOBCH20) 22" (SOBCH22) 24" (SOBCH24) 26" (SOBCH26)

42. BACK SUPPORT STDSB Standard contour back support – (19" to 28" Wide with a maximum shell height of 22") N/C

c The minimum space between the back and seat pan is 3" with a fixed back and 6" with a reclining back.

NOACB- NXTOPTIMAFHACCONTOURBACK–(19" to 21" Wide) – (E2620). $660 NOACB- NXTOPTIMAFHACCONTOURBACK–(22" to 28" Wide) – (E2621). $705

c The actual back shell heights only come in 13", 16" or 19" high.


NOPCB- NXTOPTIMAFHPCDEEPCONTOURBACK–(19" to 21" Wide) – (E2620). $660 NOPCB- NXTOPTIMAFHPCDEEPCONTOURBACK–(22" to 28" Wide) – (E2621). $705

c The actual back shell heights only come in 13", 16" or 19" high.


c This product is not compatible with Lateral Trunk Supports.

STDSBO Omission of the Contour Back Support t Specify Model of Back Support: _____________________________ N/C c It is recommended to use the Back Support option with the power or manual recline.

43. BACK SUPPORT TOTAL HEIGHT (MEASURED FROM THE SEAT PAN TO THE TOP OF THE BACK)

d 22" is the minimum back height required with a power or manual recline.

16" (SOBH16) 18" (SOBH18) 20" (SOBH20) 22" (SOBH22) 24" (SOBH24) 26" (SOBH26) 28" (SOBH28) – (This height is not available with the NXT Optima AC and PC options)

44. SEAT CUSHIONS f CG AIR – THERAPEUTIC AIR CUSHION Single valve - (19" to 21" Wide) - (E2622) Single valve - (22" to 28" Wide) - (E2623) Custom Cushion (Please use the CG Air order form)

Dual Valve - (19" to 21" Wide) - (E2624) Dual Valve - (22" to 28" Wide) - (E2625) Cell Height: 2" 3" 4"

CGA1VSCxxxx-x CG Air Single Valve (with Standard 2-way Stretch Cover) (For sizes up to 24" Wide) $510 CGA1VSCxxxx-x CG Air Single Valve (with Standard 2-way Stretch Cover) (For sizes 26"+ Wide) $610 CGA1V3Dxxxx-x CG Air Single Valve (with 3D Mesh Cover) (For sizes up to 24" Wide) $564 CGA1V3Dxxxx-x CG Air Single Valve (with 3D Mesh Cover) (For sizes 26"+ Wide) $680 CGA1VICxxxx-x CG Air Single Valve (with Incontinence Cover) (For sizes up to 24" Wide) $535 CGA1VICxxxx-x CG Air Single Valve (with Incontinence Cover) (For sizes 26"+ Wide) $625

c The actual cushion sizes only come in even numbers for width and depth measurements.

CGA2VSCxxxx-x NEW CG Air Dual Valve (with Standard 2-way Stretch Cover) (For sizes up to 24" Wide) $510 CGA2VSCxxxx-x NEW CG Air Dual Valve (with Standard 2-way Stretch Cover) (For sizes 26"+ Wide) $610 CGA2V3Dxxxx-x NEW CG Air Dual Valve (with 3D Mesh Cover) (For sizes up to 24" Wide) $564 CGA2V3Dxxxx-x NEW CG Air Dual Valve (with 3D Mesh Cover) (For sizes up to 26"+ Wide) $680 CGA2VICxxxx-x NEW CG Air Dual Valve (with Incontinence Cover) (For sizes up to 24" Wide) $535 CGA2VICxxxx-x NEW CG Air Dual Valve (with Incontinence Cover) (For sizes up to 26"+ Wide) $625

c The actual cushion sizes only come in even numbers for width and depth measurements.

c It is recommended to use the Back Support option with the power or manual recline.

f NXT BIO-FIT CUSHION d The actual cushion sizes only come in even numbers for width and depth measurements.

NXTBIOFIT - NXTBIOFITCushion–(19" to 21" Wide) – (E2607) $418 NXTBIOFIT - NXTBIOFITCushion–(22" to 24" Wide) – (E2608) $445

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45. CANTILEVER – HEIGHT ADJUSTABLE ARMRESTS – OPENS WITH A 5° ANGLE (FOR NON-RECLINING BACKS - CHOOSE 2)

SOAFBFLH Flip-BackCantilever–FullLengthLeftSide–(Height Adjustable from 7" to 15" with 1" increments) STD SOAFBFRH Flip-BackCantilever–FullLengthRightSide–(Height Adjustable from 7" to 15" with 1" increments) STD SOAFBDLH Flip-BackCantilever–DeskLengthLeftSide–(Height Adjustable from 7" to 15" with 1" increments) N/C SOAFBDRH Flip-BackCantilever–DeskLengthRightSide–(Height Adjustable from 7" to 15" with 1" increments) N/C

46. DUAL POST – HEIGHT ADJUSTABLE ARMRESTS – INCLUDES TRANSFER GRIPS (FOR NON-RECLINING BACKS - CHOOSE 2)

SOADPFLH Dual Post Height Adjustable – Full Length Left Side – (Height Adjustable from 10 1/4" to 15 1/4") – (E0973) $120 SOADPFRH Dual Post Height Adjustable – Full Length Right Side – (Height Adjustable from 10 1/4" to 15 1/4") – (E0973) $120 SOADPDLH Dual Post Height Adjustable – Desk Length Left Side – (Height Adjustable from 10 1/4" to 15 1/4") – (E0973) $120 SOADPDRH Dual Post Height Adjustable – Desk Length Right Side – (Height Adjustable from 10 1/4" to 15 1/4") – (E0973) $120

47. RECLINING FLIP-UP, HEIGHT ADJUSTABLE ARMRESTS (FOR RECLINING BACKS - CHOOSE 2)

SOANIFLH Reclining armrest – Full Length Left Side – (Height Adjustable from 10 1/2" to 14" with 1/2" increments) N/C SOANIFRH Reclining armrest – Full Length Right Side – (Height Adjustable from 10 1/2" to 14" with 1/2" increments) N/C SOANIDLH Reclining armrest – Desk Length Left Side – (Height Adjustable from 10 1/2" to 14" with 1/2" increments) N/C SOANIDRH Reclining armrest – Desk Length Right Side – (Height Adjustable from 10 1/2" to 14" with 1/2" increments) N/C

48. ARMREST HEIGHT ADJUSTMENT AT FACTORY f Please set the Armrest Height at: ________________ " c The Armrest Height is taken from the seat pan to the top of the armpad.

c Not required for Dual Post.

49. ARMPADS f FOAM TYPE SELECTION SOWAPD Desk Length Waterfall – (9") Select Side: Left Hand Side Right Hand Side STD

c The Waterfall armpads may interfere with flipping back the armrests when combined with Lateral Trunk supports.

SOWAPF Full Length Waterfall – (13 ½") Select Side: Left Hand Side Right Hand Side STD c The Waterfall armpads may interfere with flipping back the armrests when combined with Lateral Trunk supports.

f HYBRID GEL AND FOAM TYPE SELECTION (THE GEL ALWAYS STAYS SOFT) SOGELD Desk Length Hybrid Gel and Foam Flat armpad – (10" x 2 ½") Select Side: Left Hand Side Right Hand Side $35 SOGELF Full Length Hybrid Gel and Foam Flat armpad – (14" x 2 ½") Select Side: Left Hand Side Right Hand Side $35 SOWGELD Desk Length Hybrid Gel and Foam Waterfall armpad – (9") Select Side: Left Hand Side Right Hand Side $45

c The Waterfall armpads may interfere with flipping back the armrests when combined with Lateral Trunk supports.

SOWGELF Full Length Hybrid Gel and Foam Waterfall armpad – (13 ½") Select Side: Left Hand Side Right Hand Side $45 c The Waterfall armpads may interfere with flipping back the armrests when combined with Lateral Trunk supports.

f SPECIALTY TYPE SELECTION SOCAR Arm Trough with Hand Support (18" x 4 ½") – (E2209) Select Side: Left Hand Side Right Hand Side $128

c Arm Trough Armpads may interfere with Armrests Flipping back.

50. FOOTRESTS SOAAF**-STD Adult Heavy DutySwing-AwayFootrestsSet at: 60° 70° $475

Select Footrest Range: SOFLHD12 (12 ½" – 15 ½") SOFLHD14 (14 ½" – 19 ½")

ADDPLHD Heavy Duty PowerElevating&ArticulatingLegrests–(E1010) $3,895 Select Function: Individual Combined Select Footrest Range: SOFLPW12 (12 ½" - 15 ½") SOFLPW14 (14 ½" - 19 ½")

c This option includes calf pads. Individual legs count as two power functions. Combined legs count as one power function.

51. FOOTPLATES & ACCESSORIES SOSFAFHD Flip-upFootplates STD SOAFPHD AngleAdjustable&Flip-upFootplates–(Each) – (K0040) $85 SOAHL Heel Loops – (Each) – (E0951) $21 SOACPFR CalfPadsforAdultHeavy-DutySwing-Awayfootrests–(SOAAF) – with adjustable hardware – (Each) – (E0995) $38

52. FOOTREST LENGTH ADJUSTMENT AT FACTORY f Please set the Footrest Length at: ________________ " c The Footrest Length is taken from the top of the seat pan to the top of the footplate.

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53. CENTER MOUNTS SOAAF90 90°FixedCenterMountInterfaceBracket–(Offers Manual adjustability from 94° to 70°) N/C

Select Foot Platform Range: SOFBA12 (12 ½" – 16 ½") SOFBA16 (16 ½" – 19 ½") c Please Select the one piece center mount foot platform (SOFUFP) or the split footplates (SOAFPFB). c With the split footplates option (SOAFPFB), this bracket offers independent height adjustability for each footplate.

ADDPFVHD 90°Very Heavy-DutyPowerCenterMountElevating&ArticulatingFootPlatform – (E1012 / K0108) $ 3,995 Select Foot Platform Range: SOFBPW12 (10 ½"- 16") SOFBPW16 (16"- 20")

c This option includes calf pads. The power center mount counts as one power function.

c Please Select the one piece center mount foot platform (SOFUFP) or the split footplates (SOAFPFB). c For leg lengths between 10 ½" and 12 ½", there is a partial conflict where the calf pads prevent the foot platform or foot plates from folding completely.

54. FOOT PLATFORMS & ACCESSORIES SOFUFP Flip-uponepieceFootPlatform N/C SOAFPFB AngleAdjustable&Flip-upSplitFootplatesforcentermount–(Each) – (K0040) $85 SOACPCM CalfPadsfor90°FixedCenterMount–(SOAAF90) with adjustable hardware – (Each) – (E0995) $38

55. FOOT PLATFORM LENGTH ADJUSTMENT AT FACTORY f Please set the Foot Platform Length at: ________________ " c The Foot Platform Length is taken from the top of the seat pan to the top of the foot platform or split foot plates.

56. SEAT POSITIONING (NOT COMPATIBLE WITH THE WC19-ISO OPTION) SOAUTO80-STD 80"SeatPositioningStrap STD SOBPHP2C Bodypoint padded Hip Belt – (Two Point – Center Pull) – (E0978) $150 SOBPHP2C-L82 XL82"BodypointpaddedHipBelt–(Two Point – Center Pull) – (E0978) $165 SOPHB NEW PaddedHipBelt,2-PTMagneticCenterPull(E0978) $125 SOPCS NEW PaddedChestStrap,2-PTMagneticCenterPull(E0960) $186

57. HEADREST d Please select one of the headrest options with the mounting hardware and specify where the headrest will be installed.

SONUAHR Using headrest mounting hardware other than SOMAH located bellow. t Specify: _____________________________ N/C SOFHRS Small Curved Headrest Pad – 4" x 9" – (E0955) $233 SOFHRM MediumCurvedHeadrestPad–5"x10"– (E0955) $233 SOFHRL Large Curved Headrest Pad – 6" x 11" – (E0955) $233 SOMAH Multi-axisRemovableMountingHardware–(E1028) $238 SOHRBC Bracket to Mount on the Contour Back Support – (Without Recline) N/C SOHRPR Bracket to Mount on the Seat Frame – (For Reclining Backs) N/C

58. LATERAL TRUNK SUPPORTS d Please select one of the lateral pads and the adjustable & removable hardware.

SOSLS3 Adjustable Laterals with Small Curved Pads – (Each) – 3" x 5" – (E0956) $112 SOSLM4 Adjustable Laterals with Medium Curved Pads – (Each) – 4" x 6" – (E0956) $112 SOSLL5 Adjustable Laterals with Large Curved Pads – (Each)–5"x7"– (E0956) $112 SOSLHM AdjustableSwing-AwayHardwareMounts–(Each) – (E1028) $238

c (The Lateral Trunk Supports are not compatible with the NXT Optima FH PC 6" Deep Contour Fixed Thoracic Back Support (NOPCB).)

59. HIP & THIGH SUPPORTS d Please select one of the hip & thigh support pads and the adjustable & removable hardware.

SOHTSS10 AdjustableHip&ThighSupportPads–(Each)–Small10"x4"–(E0956) $112 SOHTSM12 AdjustableHip&ThighSupportPads–(Each) – Medium 12" x 5" – (E0956) $112 SOHTSL14 AdjustableHip&ThighSupportPads–(Each) – Large 14" x 6" – (E0956) $112 SOHTSARH AdjustableandRemovableHip&ThighSupportHardware–(Each) – (E1028) $238

HD (K0852/K0860/K0863)

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60. ACCESSORIES SOCH Cup Holder – (Self-Leveling) $90 SOCPH RamMountsX-GripCellPhoneHolder $120 SOTHS RamMountsX-GripSmallTabletHolder $170 SOTHL RamMountsX-GripLargeTabletHolderwithSwivel $270

61. REFLECTOR KIT REFLECT Red&WhiteReflectorKitStickers(They will not be installed – Included in a bag with the owner's manual) N/C

62. BACK PACK AND ARMREST SIDE POUCHES SOAP Armrest Side Pouch – (Comes with durable straps that can be hooked around the armrest tubes) Order: Left Side Right Side $57

If only choosing one (1) armrest pouch, please show what side it should be installed:

63. SWITCHES AND OPTIONS ASCPCP PGDT RNET Dongle and PC programmer kit $345 ASCPVR2 PGDT VR2 Dongle and PC programmer kit $895 SSBS Buddy Button Switch – (K0108) $150 SSES EggSwitch-Black–(K0108) $150 SSML Ultra Light Switch – (K0108) $155

SPECIALTY DRIVER CONTROL OPTIONS d Specialty Drive Control options all require the Omni 2 Enhanced Display & Digital Interface Box (EDIB)

64. THERAFIN SIP-N-PUFF KIT SCSNPK TherafinSip-N-PuffKit–(E2325) $1,545 SCSNPBTK TherafinSip-N-PuffBreathTubeKit–(E2326) $400

c Required with the Therafin Sip-N-Puff kit.

SCSRMSNP StealthRock-n-LockSwingawayArmforSip-N-Puff–(E1028) SWL (Swings on Left) SWR (Swings on Right) N/C c Required with the Therafin Sip-N-Puff kit.

SCSRM StealthRock-n-LockSwingawayMountforModeSwitch–(E1028) SWL (Swings on Left) SWR (Swings on Right) $395 SSES-STD Egg Switch for Changing Modes – Black – (K0108) MLH (Mount on Left) MRH (Mount on Right) N/C

c Required with the Stealth Rock-n-Lock Swing Away mount.

c The Mode Switch Type can be changed from this selection in SWITCHES & OPTIONS section.

SSBS-STD Buddy Button Switch – (Stop Switch) – Red – (K0108) N/C c Required with the Therafin Sip-N-Puff kit.

SOMAH Multi-axisHeadrestRemovableMountingHardware–(E1028) $238 c Required with the Therafin Sip-N-Puff kit.

f CHOOSE ONE (1) HEADREST PAD SOFHRS Small Curved Headrest Pad – 4" x 9" – (E0955) SOFHRM MediumCurvedHeadrestPad–5"x10"– (E0955) $233 SOFHRL Large Curved Headrest Pad – 6" x 11" – (E0955)

65. SWITCH-IT PROXIMITY HEAD ARRAY SCSIHAA Adult–3SwitchProximityHeadArraywith1/8"MonoJackformode/reverse–(E2330) $4,859 SCSRM StealthRock-n-LockSwingawayMountforModeSwitch– (E1028) SWL (Swings on Left) SWR (Swings on Right) $395 SSES-STD Egg Switch for Changing Modes – Black – (K0108) MLH (Mount on Left) MRH (Mount on Right) N/C



SSBS-STD Buddy Button Switch – (Stop Switch) – Red – (K0108) N/C c Required with the Switch-It Proximity Head Array.

SOMAH Multi-axisHeadrestRemovableMountingHardware–(E1028) $238 c Required with the Switch-It Proximity Head Array.

HD (K0852/K0860/K0863)

MKT.F25 | OF | P17021 | Rev.02




SPECIALTY DRIVER CONTROL OPTIONS (CONTINUED) d Specialty Drive Control options all require the Omni 2 Enhanced Display & Digital Interface Box (EDIB)

66. SWITCH-IT MICROPILOT LIGHT TOUCH PROPORTIONAL MINI JOYSTICK FOR CHIN / LIP CONTROL SCSIMP MicroPilotLighttouchminiProportionalJoystick–(E2312) $3,643 SCSRMMP StealthRock-n-LockSwingawayArmforChinMP–(E1028) SWL (Swings on Left) SWR (Swings on Right) $395

c Required with the Switch-It Proximity Micro-Pilot.

SCSRM StealthRock-n-LockSwingawayMountforModeSwitch–(E1028) SWL (Swings on Left) SWR (Swings on Right) $395 SSES Egg Switch for Changing Modes – Black – (K0108) MLH (Mount on Left) MRH (Mount on Right) $150



JCC Chin Cup – (E2324) $55 SOMAH Multi-axisHeadrestRemovableMountingHardware–(E1028) $238

c Required with the Switch-It Proximity Micro-Pilot.

f CHOOSE ONE (1) HEADREST PAD SOFHRS Small Curved Headrest Pad – 4" x 9" – (E0955) SOFHRM MediumCurvedHeadrestPad–5"x10"–(E0955) $233 SOFHRL Large Curved Headrest Pad – 6" x 11" – (E0955)

67. PROPORTIONAL COMPACT OR MINI JOYSTICK FOR MIDLINE MOUNT SCPGMJS PGDrivesJC200ProportionalCompactRemoteJoystickforMidlineMount–(E2373) $1,395 SCGMJSM GatlinMidlineSwing-awayMountforJC200–(E1028) MLH (Mount on Left) MRH (Mount on Right) $260

c Must be selected for use with the PG Drives JC200 Mini Joystick.

SCSIMP Switch-ItMicroPilotLighttouchminiProportionalJoystick–(E2312) $3,643 SCGMPM GatlinMidlineSwing-awayMountforMicroPilot–(E1028) MLH (Mount on Left) MRH (Mount on Right) $260

c Must be selected for use with the Switch-It MicroPilot.

SCBTM Bullet Hand Tray for MicroPilot – (K0108) MLH (Mount on Left) MRH (Mount on Right) $395 c This option is only compatible with the Switch-It MicroPilot.

68. PROPORTIONAL COMPACT OR MINI JOYSTICK FOR ARMREST MOUNT SCPGMJS PGDrivesJC200ProportionalCompactRemoteJoystickforArmrestMount–(E2373) $1,395 SCARMJSM Swing-awayandMulti-Axisarmrestmount–(E1028) MLH (Mount on Left) MRH (Mount on Right) $244

c Must be selected for use with the PG Drives JC200 Mini Joystick.

SCSIMP Switch-ItMicroPilotLighttouchminiProportionalJoystick–(E2312) $3,643 SCARMPM Swing-awayandMulti-Axisarmrestmount–(E1028) MLH (Mount on Left) MRH (Mount on Right) $244

c Must be selected for use with the Switch-It MicroPilot.

SCBTM Bullet Hand Tray for MicroPilot – (K0108) MLH (Mount on Left) MRH (Mount on Right) $395 c This option is only compatible with the Switch-It MicroPilot.

69. PROPORTIONAL RIM HEAD CONTROL PACKAGE SCPHC Proportional RIM Head Control Package – (E2327) $4,595 SCSRM StealthRock-n-LockSwingawayMountforModeSwitch–(E1028) SWL (Swings on Left) SWR (Swings on Right) $395 SSES-STD Egg Switch for Changing Modes – Black – (K0108) MLH (Mount on Left) MRH (Mount on Right) N/C



SOMAH Multi-axisHeadrestRemovableMountingHardware–(E1028) $238 c Required with the Proportional RIM Head Control.

HD (K0852/K0860/K0863)

MKT.F25 | OF | P17021 | Rev.02




CUSTOM SECTION f Lead times will increase depending on the custom order pipeline at the time the purchase order is received. Please call for Quote and specifications for these options.

70. O2 HOLDER SUPOXY CustomNon-ArticulatingOxygenTankHolder–(E2208) MLH (Mount on Left) MRH (Mount on Right) $270

c Not available with a power tilt and/or power recline.

SUPOXYA Custom Articulating Oxygen Tank Holder – (K0108) MLH (Mount on Left) MRH (Mount on Right) $1,195 c Required with a power tilt and/or power recline.

D-Size Oxygen Tank – (* 22" Tall x 4.3" Diameter) – * The height includes the valve

E-Size Oxygen Tank – (* 31" Tall x 4.3" Diameter) – * The height includes the valve

71. VENT TRAY (PLEASE COMPLETE IN FULL)

d Amysystems does not supply the battery, charger or the wiring for the Vent. These items are normally provided by the Vent Manufacturer.

SOVENT Custom Vent Tray Articulating Vent Box – (Required with Power Tilt and/or Recline) – (E1030) $1,420 Fixed Vent Box – (E1029) $400 SPECIFY MODEL Trilogy 100/200 LTV LTV with Sprintpack Other, specify: ______________________________________________________________________________________________________

SOVTBE Extended Battery Compartment – (K0108) $495 c The Vent Tray option is not available with the CUSTOM Battery Tray for Group 24 Batteries with a 24" frame width (FS2424B).

The Vent is being powered by 1 U1 Battery and the chair by 2 Group 24 batteries The Vent is being powered by 1 Group 22NF Battery and the chair Powered by 2 Group 24 batteries

72. OTHER CUSTOM OPTIONS (REQUEST FOR QUOTE)

d Please specify details and specifications for these options.

CUSTOM NEW MilitaryPatch-ARMY N/C CUSTOM NEW MilitaryPatch-NAVY N/C CUSTOM NEW MilitaryPatch-AIRFORCE N/C CUSTOM NEW MilitaryPatch-MARINECORPS N/C CUSTOM NEW MilitaryPatch-COASTGUARD N/C CUSTOM NEW Rear view Camera with 5" Monitor $995 CUSTOM NEW USB Charger Port t Specify the location for the installation: _____________________________ $345 CUSTOM Manual Wheel Locks $345 CUSTOM Non Standard Frame Colors – (Not all custom colors are available, please contact CSR for availability) $295 CUSTOM Power Anterior Tilt RFQ CUSTOM Independent Depth Adjustability built into the Footrest Receiver that is attached to the Seat Pan RFQ CUSTOM Endomorphic Back Canes – (Pair) 1" per side towards the inside = 2" 2" per side towards the inside = 4" RFQ CUSTOM Transfer Handles – (Pair) RFQ CUSTOM # 1 Other custom options. Specify in notes section below RFQ CUSTOM # 2 Other custom options. Specify in notes section below RFQ

HD (K0852/K0860/K0863)

MKT.F25 | OF | P17021 | Rev.02




73. NOTES / SPECIAL REQUESTS / CUSTOM SPECIFICATIONS

THE ORDER CANNOT BE PROCESSED WITHOUT THE FOLLOWING

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