Invacare eForms

1 For additional information, visit Service: 800-333-6900 Fax: 800-678-4682 To order Literature: 800-828-6282 Invacare eFormsInvacare eForms offer new functionality! Invacare is pleased to offer you an upgraded solution to your ordering process. Our enhanced order forms allow you to fill out a form electronically, print and fax the form, save and email* it to Customer Service, or maintain the business practices that work for you today.

2 The format has been revised to reveal a cleaner look with electronic selection and input functions. *Saving and emailing the eForms is available with Acrobat Professional softwareIf you are using Adobe Reader View and download all forms Save blank versions of the forms to your desktop Complete forms electronically Print blank or completed forms Fax completed forms to Customer Service Please note: The 'Email' button at the end of the form will not work with Adobe Reader. The 'Email' button will only work while using Adobe Acrobat you are using Adobe Acrobat Professional View and download all forms Save blank AND completed versions of the forms to maintain electronic records Complete forms electronically Print blank or completed forms Fax completed forms to Customer Service Email completed forms to Customer Service by using the 'Email' button at the end of the form.

3 For information on downloading Adobe Reader for free, or puchasing Adobe Acrobat Professional, please visit NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to 1 of 3 Invacare IVC tracer ex2 Wheelchair Customer Service: 800-333-6900 Fax: 800-678-4682 To order literature: 800-828-6282 Price List and Order Phone #Company NameAddress City Zip Code Account # # State CountryContact Name CommentsOrderQuoteTRANSACTION TYPE:Special NoteHCPCS codes are not intended to be, nor should be considered billing or legal advice.

4 Providers are responsible for determining the appropriate billing codes when submitting claims to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail. T93 HAP Hemi Footrests with Aluminum Footplates and Heel Loops (9153637801) .. $ T93 HCP Hemi Footrests with Composite Footplates and Heel Loops (9153637786) .. $ AHL4AP Hemi Smartleg Articulating Legrests with Aluminum Footplates and Padded Calf Pads (9153619911).

5 $ T94 HCP Hemi Elevating Legrests with Composite Footplates and Padded Calf Pads (9153637788) .. $ T94 HAP Hemi Elevating Legrests with Aluminum Footplates and Padded Calf Pads (9153637804) .. $ FRONT RIGGING OPTIONS T93 HEP Economy Hemi Footrests without Heel Loops, Composite Footplate (9153637918) .. $ E0990E0951E0951K0195E0990K0053 T94 HEP Economy Hemi Elevating Legrests with Non-padded Calf Pads and Composite Footplate (9153637919) .. $ Number Description List PriceQuantityNOTE: All specifications and dimensions are approximate.

6 For the most current pricing information, go to No. 02-078L TREX26RP 16" x 16" Frame with Removable Fixed Height, Desk Length Arms (9153637773) ..$ TREX26 RFP 16" x 16" Frame with Removable Fixed Height, Full Length Arms (9153645183) ..$ TREX28RP 18" x 16" Frame with Removable Fixed Height, Desk Length Arms (9153637774) .. TREX28PP 18" x 16" Frame with Permanent Arms (9153637782) .. $ TREX28 FFP 18" x 16" Frame with Permanent Arms and Fixed Footrest (9153637776) .. $ WHEELCHAIR CONFIGURATIONS TREX28 RFP 18" x 16" Frame with Removable Fixed Height, Full Length Arms (9153637784).

7 $ TREX20PP 20" x 16" Frame with Permanent Arms (9153645182) .. $ TREX20 RFP 20" x 16" Frame with Removable Fixed Height, Full Length Arms (9153645181) .. $ TREX20RP 20" x 16" Frame with Removable Fixed Height, Desk Length Arms (9153637775) ..$ Model Number Description List PriceQuantityRevised December 11, 2014 Invacare IVC tracer ex2 Wheelchair ARMSE097319ST Full Length Adjustable Height Arms (10" -14" Adjustable Range) (9153645340) .. $ 29ST Desk Length Adjustable Height Arms (10"-14" Adjustable Range) (9153645339).

8 $ Model Number Description List PriceQuantityANTI-TIPPERSE0971 1360 Adjustable Anti-Tippers (Does not fit fixed frame model) (9153629710) .. $ available on Fixed Frame model. Model Number Description List PriceQuantity 1329 BKST 8" Wheel Lock Extensions (9153645341) .. $ 1335ST Non-Folding Device (9153645342) .. $ 1496 IV/Oxygen Cylinder Holder Package Assembly (9153632659) .. $ 1515ST Push Button Style Seat Positioning Strap (9153645344).

9 $ 1514 Overhead Anti-Theft Device (9153602056) .. $ ACCESSORIESE0961E0978E2208 1497 Oxygen Cylinder Holder Package Assembly (9153632671) .. $ 1820ST Non-Removable Device for Front Riggings (9153645345) .. $ available on Fixed Frame model. Model Number Description List PriceQuantityNOTE: All specifications and dimensions are approximate. For the most current pricing information, go to Corporation USA One Invacare Way Elyria, OH USA 44035-4190 800-333-6900 2013 Invacare Corporation All rights reserved.

10 Trademarks are identified by the symbols and . All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Specifications and prices are subject to change without notification. Specifications Seat Widths 16", 18", or 20" Overall Width * Permanent Arm - Seat Width plus 7 1/4" * Removable Arm - Seat Width plus 8 " Seat Depth 16" Overall Depth 31 7/8" (18 x 16 without Front Riggings) Back Height 16" Seat-to-floor 17 1/2" or 19 1/2" (21" on Fixed Frame) Weight Limit 250 lbs.