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The Bahamas
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Cape Verde
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Central African Republic
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Chile
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Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
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Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
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Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana Guyana
Haiti Haiti
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Laos
Latvia
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Libya
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Mali
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Monaco
Mongolia
Montenegro
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Namibia
Nauru
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New Caledonia
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Niger
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Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Pakistan
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Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Transnistria Pridnestrovie
Puerto Rico
Qatar
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Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tristan da Cunha
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P.O. # (if placing new order)
Mark For:
Backrest Options
Shell Type:
Aluminum
Carbon Fiber (13" - 19" wide ONLY)
Wheelchair Width:
10” / 25.4cm (Aluminum only)
11” / 28cm (Aluminum only)
12” / 30.5cm (Aluminum only)
13” / 33cm
14” / 35.5cm
15” / 38cm
16” / 40.6cm
17” / 43cm
18” / 45.7cm
19” / 48cm
20” / 51cm (Aluminum only)
Back Height:
Low 10” / 25.4cm
Med 13” / 33cm
Std 16” / 40.6cm
Tall 18” / 45.7cm (Aluminum only)
Extra Tall 20” / 51cm (Aluminum only)
Contour:
Active (2.5" / 63.5mm)
Deep (4" / 100mm)
Mounting System
Fixed Elite (Carbon Only)
2-Point Pro (Aluminum Only in US,CAN, AUS and NZ)
Quick Release
e-Clamp (Aluminum Only in US,CAN, AUS and NZ)
Back Support Accessories
Privacy Flap
PSIS / Lumbar Support
Loop Handle (Aluminum Quick Release Only)
Drill for Headrest (Aluminum Only)
Lateral Support Pads
Small (3"H x 3"D) Right Side - EA
Small (3"H x 3"D) Left Side - EA
Med (3"H x 4"D) Right Side - EA
Med (3"H x 4"D) Left Side - EA
Large (4.5"H x 4.5"D) Right Side - EA
Large (4.5"H x 4.5"D) Left Side - EA
XLarge (4"H x 6"D) Right Side - EA
XLarge (4"H x 6"D) Left Side - EA
Lateral Support Hardware
Stationary
Swing-Out
Special Instructions / Notes
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