Invacare eForms

1 Invacare eForms For additional information, visit Customer Service: 800-333-6900 Fax: 800-678-4682 To order Literature: 800-828-6282. Invacare 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. 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 software If you are using Adobe Reader If you are using Adobe Acrobat Professional View and download all forms View and download all forms Save blank versions of the forms to your desktop Save blank AND completed versions of the forms Complete forms electronically to maintain electronic records Print blank or completed forms Complete forms electronically Fax completed forms to Customer Service Print blank or completed forms Fax completed forms to Customer Service Email completed forms to Customer Service by using Please note: The 'Email' button at the end of the form will not work with Adobe Reader.

2 The 'Email' button will only work while using the 'Email' button at the end of the form. Adobe Acrobat Professional. 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 Page 1 of 10. Invacare Rehab Seating and Positioning Products Price List and Order Form Customer Service: 800-333-6900 Fax: 800-678-4682 To order literature: 800-828-6282. TRANSACTION TYPE: Order Quote Date Account # #. Company Name Phone #. Address City State 0 Zip Code Country Contact Name Comments ABSOLUTE CUSHIONS .. page 3-4 BACKS .. page 7. Absolute Cushion intouch Propel Back Single Density Cushion Curved Back Comfort Mate Extra Cushion Curved Back Pneumatic Invacare Versair Back intouch CUSHIONS.

3 Page 5. intouch Stabilite OM ACCESSORIES .. page 8-9. Cushion Rigidizer ULTIMATE CUSHIONS .. page 6 Adductors Ulti-Mate Junior Cushion Flip-down Abductors Ulti-Mate Adult Cushion Laterals for Curved Back Ulti-Mate Junior Base Cushion Universal Headrest Adapter Plate Ulti-Mate Adult Base Cushion Headrest Systems Cushion Repair Kit Lap Belts Shoulder Supports Infinity Drop Bases Full Tray - Hook and Loop Mount Full Trays - Slide-On Half Lap Trays - Swingaway Wheelchair Tray Accessories KSS SEATING SYSTEM .. page 10. KSS Kinesthetic Seating System KSS Deluxe Seating System NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to Revised July 30 , 2012 Form No. 07-027. Invacare Rehab Seating and Positioning Products Invacare ABSOLUTE CUSHION SINGLE DENSITY CUSHION.

4 General Purpose Cushion General Purpose Cushion EC Absolute Cushion .. $ E2601. E2601. SD Single Density ..$ E2602. EC66 Absolute Cushion 16x16 .. $ E2601. CWC/(Size) Single Density Replacement Cover .. $ EC68 Absolute Cushion 16x18 .. $ E2601 ABSOLUTE AND SINGLE DENSITY. EC86 Absolute Cushion 18x16 .. $ E2601 CUSHION BUILDER SIZES. SEAT WIDTH. EC88 Absolute Cushion 18x18 .. $ E2601. W10 10" Wide .. No Charge EC06 Absolute Cushion 20x16 .. $ E2601 W11 11" Wide .. No Charge W12 12" Wide .. No Charge EC08 Absolute Cushion 20x18 .. $ E2601 W13 13" Wide .. No Charge W14 14" Wide .. No Charge CW/(Size) Absolute Replacement Cover .. $ W15 15" Wide .. No Charge W16 16" Wide .. No Charge Size Chart for Absolute and Single Density Cushions W17 17" Wide .. No Charge Depth (in) W18 18" Wide .. No Charge 7 8 9 10 11 12 13 14 15 16 17 18 19 20.

5 Width (in). W19 19" Wide .. No Charge 10 X X X X X X X X X X W20 20" Wide .. No Charge 11 X X X X X X X X X X W21 21" Wide .. No Charge 12 X X X X X X X X X X W22 22" Wide .. +$ 13 X X X X X X W23 23" Wide .. +$ 14 X X X X X X X X X W24 24" Wide .. +$ 15 X X X X X X X X X. 16 X X X X X X E X E X X SEAT DEPTH. 17 X X X X X X X D7 7" Deep .. No Charge 18 X X E X E X X D8 8" Deep .. No Charge D9 9" Deep .. No Charge 19 X X X X X. D10 10" Deep .. No Charge 20 E X E X X. D11 11" Deep .. No Charge 21 X X X X X. D12 12" Deep .. No Charge 22 X X X X X. D13 13" Deep .. No Charge 23 X X X X X D14 14" Deep .. No Charge 24 X X X X X D15 15" Deep .. No Charge E=Absolute X = Builder (Single Density) D16 16" Deep .. No Charge D17 17" Deep .. No Charge D18 18" Deep .. No Charge D19 19" Deep .. No Charge D20 20" Deep.

6 No Charge NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to Revised July 30 , 2012 Form No. 07-027. Invacare Rehab Seating and Positioning Products Invacare COMFORT-MATE EXTRA COMFORT MATE EXTRA BUILDER SIZES. CUSHION SEAT WIDTH. Skin Protection Cushion W14 14" Wide .. No Charge W15 15" Wide .. No Charge W16 16" Wide .. No Charge W17 17" Wide .. No Charge W18 18" Wide .. No Charge W19 19" Wide .. No Charge Actual cushion width is 1" narrower than stated size W20 20" Wide .. No Charge Actual cushion depth is 1" longer than stated size W21 21" Wide .. No Charge E2603. CMEX Comfort Mate Extra .. $ E2604 W22 22" Wide .. +$ CMEX66 Comfort Mate Extra 16x16 .. $ E2603. SEAT DEPTH. CMEX68 Comfort Mate Extra 16x18 .. $ E2603 D14 14" Deep .. No Charge D15 15" Deep.

7 No Charge CMEX86 Comfort Mate Extra 18x16 .. $ E2603. D16 16" Deep .. No Charge E2603. D17 17" Deep .. No Charge CMEX88 Comfort Mate Extra 18x18 .. $ D18 18" Deep .. No Charge CMEX06 Comfort Mate Extra 20x16 .. $ E2603 D19 19" Deep .. No Charge D20 20" Deep .. No Charge CMEX08 Comfort Mate Extra 20x18 .. $ E2603. CMEXC/(Size) Comfort Mate Extra Outer Cover .. $ COMFORT MATE EXTRA CUSHION SIZE CHART. Depth (in). 14 15 16 17 18 19 20. Width (in). 14 X X X. 15 X X X X X X. 16 X S X S X S. 17 X X X X X X. 18 X S X S X S. 19 X X X X X X. 20 X X X X. 21 X X X X. 22 X X X X. S = Standard X = Builder NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to Revised July 30 , 2012 Form No. 07-027. Invacare Rehab Seating and Positioning Products intouch STABILITE OM CONFIGURED/BUILDER SIZES.

8 Positioning Cushion SEAT WIDTH. Product weight capacity on Seat Width 15" - 20" is 300 lbs. Weight capacity on Seat Widths 21" - 24" is 500 lbs. W14 14"Wide .. No Charge Stabilite OM Only W15 15"Wide .. No Charge W16 16"Wide .. No Charge W17 17"Wide .. No Charge Bottom View Incontinence cover is standard. W18 18"Wide .. No Charge W19 19"Wide .. No Charge E2605. ITSOM intouch Stabilite OM .. $ E2606 W20 20"Wide .. No Charge W21 21"Wide .. No Charge ITSOM66 intouch Stabilite OM 16x16 .. $ E2605 W22 22"Wide .. $ $ upcharge for widths 22", 23" and 24". ITSOM68 intouch Stabilite OM 16x18 .. $ E2605 W23 23"Wide .. $ $ upcharge for widths 22", 23" and 24". ITSOM86 intouch Stabilite OM 18 x16 .. $ E2605 W24 24"Wide .. $ $ upcharge for widths 22", 23" and 24". ITSOM88 intouch Stabilite OM 18x18 .. $ E2605 SEAT DEPTH.

9 ITSOM06 intouch Stabilite OM 20x16 .. $ E2605 D14 14" Deep .. No Charge D15 15" Deep .. No Charge ITSOM08 intouch Stabilite OM 20x18 .. $ E2605 D16 16" Deep .. No Charge D17 17" Deep .. No Charge ITSOMC/(size) intouch Stabilite OM Outer Cover .. $ D18 18" Deep .. No Charge intouch STABILITE OM ACCESSORIES D19 19" Deep .. No Charge D20 20" Deep .. No Charge SOIPR/(Size) Additional Stabilite OM Obliquity Inserts (Pr) .. $ D21 21" Deep .. No Charge ITSTAB intouch Stabilite OM Thin Air Bladder .. $ D22 22" Deep .. No Charge Stabilite OM Size Chart MODIFICATIONS Depth (in). 14 15 16 17 18 19 20 21 22. RLW Removable 1" Leg Wedges .. $ Width (in). LLD-L1 Leg Length Cut Out 1" User's Left .. $ 14 C C C C C. LLD-R1 Leg Length Cut Out 1" User's Right .. $ 15 C C C C C C. LLD-L2 Leg Length Cut Out 2" User's Left.

10 $ 16 C S C S C C. LLD-R2 Leg Length Cut Out 2" User's Right .. $ 17 C C C C C C. POK Pelvic Obliquity Kit .. $ 18 C S C S C C. 19 C C C C C C. Modifications to cushions must be ordered with the cushion and 20 C S C S C C. cannot be ordered separately. 21 C C C C C C C. 22 C C C C C C C. 23 C C C C C C C. 24 C C C C C C C. S=Non Configured (Standard) C=Configured (Builder). Level Pelvis One half-inch adjustment One-inch adjustment Note: On all Stabilite OM cushions the actual depth dimensions will be slightly longer than the wheelchair dimensions due to the posterior The Stabilite OM cushion was designed to address mild and moderate pelvic lip which allows for good pelvic positioning. This extra depth pelvic obliquities, now or in the future. does not affect the actual seating depth. NOTE: All specifications and dimensions are approximate.