PinDot Series ContourU For ease of ordering, …

1 PinDot Series ContourU order FormRev. 10/20/09 Send Cast / Splint and order form to PinDot Custom SeatingAttn: ContourU , 899 Cleveland St. Elyria, OH 44036 For Skribbl'r Digitizing Systems: E-mail order form and Digitized File to:Molding Bag MeasurementsMobility Base Information / Cushion DimensionsCenter Shapes orLeave as MarkedAccessories* (doesn't work with Freedom t-nut pattern)Seat to Back Junctions Comments and Special InstructionsAR20 Desk Length ArmrestPelvic ControlN/AHR02S Large Headrest includes Adapter PlateHR03S 2-Step Headrest includes Adapter PlateHR04S Curved Headrest includes Adapter PlateHR15 Headrest Adapter Plate *For ease of ordering , contact PinDot Customer Service Toll Free at: 800-451-3553 Fax: 800-834-4153 Company Contact Name:Phone Number:Best Time to Contact:Ship To Address:E-mail Address:Account #:Cell Phone Number:City/State/Zip:Client Name:Purchase order #.

2 Certification #:Fax Number:Penny Location/ # of PenniesDescriptionMolding Bag:Modify To: A / (2)Chest WidthN/AinininN/AN/AB / (2)Waist WidthC / (2)Hip WidthD / (1)Leg Length / RightE / (1)Leg Length / LeftinN/AF / (1)Back HeightG / (1)Top of Lateral Height-RightH / (1)Top of Lateral Height-LeftN/ACenter Lines:Seat-Back Angle, in Degrees = Model:Is This order Going "With Chair" (Invacare Chair)Frame Depth:inFrame Width:Is This order Going "On Chair" (Invacare Chair)When ordering cushions "With Chair" or "On Chair" fax this order form and the order forthe Invacare Chair to PinDot Customer Service at 1-800-834-4153SB05 ContourU Pelvic Extra Strong LinksTR40L Tray Receptacle - LeftTR40R Tray Receptacle - RightHR01S Small Headrest includes Adapter PlateUniversalJunctionGrowth in InchesBack Tube Diameter:Inside Rail Width:Inside Back Cane Width.

3 IninSeat Tube DiameterLB07 Small FootrestLB08 Large FootrestOpen to RearLT06 Legrest TopsGL01 Regular linksGL10 Dial Links - Required if Seat to Back Angle is > 105 FullTongueFixed Recline (>105)N/AFull OnlyNoTongueFullN/AYesTongueHip Control(Refer to Price List for details)BOLD print selections are priced individually,inSeat Cushion Width:Back Cushion Width:Brand:1034744 Chest Positioning of GapStyle of GapAR24 Full Length ArmrestC u s t o m S e a t in gSeat Cushion SpecificationsStandard FoamSoft FoamCovering Options MountingCover StyleDraw String (Std)If Leg Length Discrepancy, Size Pan to fit: 2 Piece w/VelcroShort Leg orLong Leg Mounting HardwareSpecify Non-Std T-Nut Pattern: * Wood Stiffeners are Std on Cushions Without a Wood Mount Seat ModificationsCM22 Rail Cut - Finished Rail Cut Width =CM38 Loose Fit (1/4" Increments)CM13 Undercut - RightCM13 Undercut - LeftCM40 Diagonal CutShow Placement on Cast/Image for These ModificationsCM12 Pelvic Strap Notches, 2" StandardCM33 Cross-Brace Notches, Refer to Tech NotesCM17 Notched Rear Corners, 1" x 2" StandardCM20 Strap Slots, 1/2" x 1 1/2" Standard - Naked OnlyVF05 Visco Foam Overlay 1/2"VF01 Visco Foam Overlay 1"SF05 Standard Sofspot Foam Overlay 1/2" Comments and Special InstructionsSF01 Standard Sofspot Foam Overlay 1"For Office use OnlyLonger/Shorter After RollCM06 Wood Mount without T-NutsinchesFDI-538 Econo-Eze (includes Seat & Back Hardware)

4 OCMK01 J & L Brackets - 1 inch (rail cut only)OCMK78 J & L Brackets - 7/8 inch (rail cut only)CM06T Wood Mount with T-NutsSO40 Inner Moisture Resistant CoverQtySeat Width: inchesQtySAV Sage Green VinylTAV Taupe VinylGMV Gunmetal Gray VinylBKV Black VinylWWV Wedgewood Blue VinylPGV Purple Gray VinylCM47 RaisedCM46 As MoldedinchesAdductor - RightL-19 Burgundy Rubber Backed LycrainchesCM31 Upholstered Bottom without VelcroFabric: CM03 UntrimmedCM31V Upholstered Bottom with VelcroSeat Length:TFNP New PanTFEP To Fit Existing Pan: HWWMK78 Wood Mounting Kit - 7/8 inch1 or 2 inchHWWMK01 Wood Mounting Kit - 1 inchinchesinchesCM01S Vinyl Upholstery (Non Removable)Qty Additional Cloth CoversCM54 As Molded CM47 RaisedCM48 Standard ReinforcedCast / Digital Front Rigging NotchesWidth:RailCutWidth CM50 L - Shaped ReinforcedCM80 Aluminum ReinforcedAbductorSplintDepth:Depth:Qty: CM09P Duplicate Sofspot Pad (Vinyl Only)1 or 2 inch1 or 2 inchName:CM37 RaisedCM34 ExtendedinchesCM09V Sofspot - Visco FoamAdductor - LeftCM46 As MoldedCM36 ExtendedinchesReturned CushionsinchesSerial No.

5 # of Cushions Depth:Intake inchesAdductor ReinforcementCM36 ExtendedLength:Set-UpPullLength AuditCM02S Naked (Removable Cloth Cover Included)CMP PolartekCMS LycraCMD Darlexx * (moisture resistant material)DT-2 Standard Dartex * (moisture resistant material)DT-2R Reversed Dartex * (moisture resistant material)L-05 Black Rubber Backed LycraL-06 Gray Rubber Backed LycraL-15 Teal Rubber Backed LycraL-18 Purple Rubber Backed LycraL-13 Light Blue Rubber Backed LycraL-14 Red Rubber Backed LycraL-20 Blue Rubber Backed LycraL-23 Green Rubber Backed LycraL-24 Tytex Spacer FabricCM30G Recess with Gel Pad InsertHWPMK01 Pan Mounting Kit - 1 inchHWPMK78 Pan Mounting Kit - 7/8 inchinchesinchesDepth:Qty:CM30 Recess OnlyQty:CM09 Sofspot - Std FoamCM78S Additional Cover for Vinyl CushionCM76S Additional Cover for Naked CushionOverlays only available on Naked CushionBack Cushion SpecificationsStandard FoamSoft FoamCovering OptionsCover StyleDraw String (Std)2 Piece w/Velcro Mounting Mounting HardwareHWABK Adjustable Back Mounting HardwareHWPMK01 Pan Mounting Kit - 1 inchHWPMK78 Pan Mounting Kit - 7/8 inchHWWMK01 Wood Mounting Kit - 1 inchHWWMK78 Wood Mounting Kit - 7/8 inchOCMK01 J & L Brackets - 1 inch(rail cut only)OCMK78 J & L Brackets - 7/8 inch(rail cut only)FDI-596 Econo-Eze (Back Hardware Only)Specify Non-Std T-Nut Pattern.

6 * Wood Stiffeners are Std on All Cushions Without a Wood Mount Back ModificationsCM22 Rail Cut - Finished Rail Cut Width =CM38 Loose Fit (1/4" Increments)CM13 UndercutCM40 Diagonal Cut Strap Slots Available on Naked Only and Cannot Intersect a Sofspot Comments and Special InstructionsFor Office use OnlyForm # 00-285SO40 Inner Moisture Resistant CoverDT-2R Reversed Dartex * (moisture resistant material)L-05 Black Rubber Backed LycraL-06 Gray Rubber Backed LycraL-20 Blue Rubber Backed LycraL-23 Green Rubber Backed LycraL-24 Tytex Spacer FabricFDI-538 Econo-Eze (includes Seat & Back Hardware)Lateral - RightCM49 As MoldedShow Placement on Cast/Image for These ModificationsCM20 Strap Slots 1/2" x 1 1/2" StandardTFEP To Fit Existing Pan: CM31 Upholstered Bottom without VelcroCM31V Upholstered Bottom with VelcroinchesBack Width: Back Height:CM03 UntrimmedCM06T Wood Mount with T-NutsQtyTFNP New PanFabric: CM76B Additional Cover for Naked CushionL-19 Burgundy Rubber Backed LycraCMS LycraCMD Darlexx * (moisture resistant material)TAV Taupe VinylSAV Sage Green VinylGMV Gunmetal Gray VinylDT-2 Standard Dartex * (moisture resistant material)CMP PolartekCM02B Naked (Removable Cloth Cover Included)QtyBKV Black VinylWWV Wedgewood Blue VinylCM01B Vinyl Upholstery (Non Removable)TFCS-Fit to Custom Shell.

7 PGV Purple Gray VinylCM78B Additional Cover for Vinyl CushionQty Additional Cloth CoversinchesLateral - LeftCM49 As MoldedCM30G Recess with Gel Pad InsertCM52 Extend Existing ShapeCM52 Extend Existing Shapeinchesinches1 or 2 inchDepth:CM09 Sofspot - Std FoamQty:inchesCM09P Duplicate Sofspot Pad (Vinyl Only)** Swing Away Laterals must be accompanied by CM21CM39 L - Shaped ReinforcedIntake Serial No. # of Cushions CushionsSplintWidth Set-UpAuditPullLength Tongue After Roll Rail Cut Name: CM30 Recess OnlyQty:Cast / Digital FileVF01 Visco Foam Overlay 1"CM06 Wood Mount without T-NutsDepth:Depth:Qty:CM09V Sofspot - Visco FoamVF05 Visco Foam Overlay 1/2"1 or 2 inchinchesinches1 or 2 inchCM51 Square PullinchesLateral ReinforcementCM16 Standard ReinforcedCM21 Aluminum ReinforcedL-13 Light Blue Rubber Backed LycraL-14 Red Rubber Backed LycraL-15 Teal Rubber Backed LycraL-18 Purple Rubber Backed LycraCM534L Swing Away Lateral Left (Naked Only)CM51 Square PullinchesCM534R Swing Away Lateral Right (Naked Only)SF05 Standard Sofspot Foam Overlay 1/2"SF01 Standard Sofspot Foam Overlay 1"Overlays only available on Naked Cushio