Order Form Netti III XHD 65-75 cm

SW 65-75 cm
Date ____________________________
Customer code C-______________________
Invoice address ___________________
Contact person ________________________
________________________________
Reference ____________________________
________________________________
Other delivery address __________________
________________________________
_____________________________________
________________________________
_____________________________________
Invoice address = delivery address
Quote
Basic price 7.699,- €
Excl. VAT
Seat width
X20065
X20070
X20075
65 cm
70 cm
75 cm
Seat depth A
B
C
D
E
Capacity
Seat height
D22149
50,0 cm
47,5 cm
45,0 cm
42,5 cm
40,0 cm
Max. 200 kg
See page 6
Side upholstery (reduces SW with 2 x 2,5 cm)
129,- €
= Standard equipment
FRAME
Item nr.
Description
Price in €
Standard
Push handles 30 cm, height adjustable and swingable
0,-
Standard
Anti tip w/ pedal
0,-
D21808
Push handles 50 cm, height adjustable and swingable
189,-
D20824
Frame extension incl. brakes on lower frame tube
269,-
D41074
Car fastener
158,-
SOLUTIONS FOR RESPIRATION MACHINES AND OTHER MEDICAL DEVICES
X21186
X21187
D42900
Universal device holder (incl. frame extender D20824)
D: 34,8 cm / W: SW minus 3,6 cm / Max. capacity 10kg
Cover plate for universal device – add. Level (only with X21186)
D: 19,3 cm / W: SW minus 3,7 cm / H (free area): 23,7 cm
Extra set of 4 mounting brackets, incl. screws
1926,592,234,-
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 1 of 7
Version 2017-01 #6
SW 65-75 cm
BRAKES
Standard
D21010
D21029
D21031
User brake, brake lever 9 cm
Drum brakes
Brake lever extension + 6 cm, length: 15 cm
Brake lever extension + 16 cm, length: 25 cm
0,229,69,79,-
BACK UNIT (for belts please see page 4)
Standard
Standard
X21006
D44992
X21123
X21124
D26831
D26844
D27541
X27702
X27703
D21042
D21084
Back cushion Netti Stabil - side support 17 cm, 3D cover
Back height 50 cm (incl. adjustable velcro back)
Back height 60 cm (incl. back extender + longer cushion)
Adjustable velcro with cut for side supports
Back cushion Netti SUPER STABIL for SW 65-70 cm - with 17 cm
reinforced side support - 3D cover
Back cushion Netti SUPER STABIL for SW 75 cm - with 17 cm
reinforced side support - 3D cover
Side support stable left – for Netti STABIL and SUPER STABIL
Side support stable right – for Netti STABIL and SUPER STABIL
Upholstery for side support stable, pair
Firm back in aluminium, back height 50 cm
Firm back in aluminium, back height 60 cm, incl. X21006
Lumbar support
Back wedge
0,0,294,236,897,897,219,219,134,333,467,164,164,-
SEAT UNIT (for belts please see page 4)
Standard
Standard
X21125
D27490
D27491
D27492
D20830
Netti Sit - anti-decubitus cushion with incontinence layer under the 3D
Reinforced seat plate
Vital Base Royal, anti-decubitus cushion with temperature regulating
cover – only for SW 65 + 70 cm
Abduction block small (W: 8 x L: 14 x H: 8 cm)
Abduction block medium, (W: 11 x L: 15 x H: 8 cm)
Abduction block large, (W: 14 x L: 17 x H: 8 cm)
Removable knee and thigh support
1 piece
2 pieces
0,0,912,235,235,235,188,-
LEG SUPPORTS AND ACCESSORIES
Standard
D21008
D21745
D23014
Reinforced leg supports, manual adjustable leg rests with automatic
length adjustment, angle adjustable footboard, calf supports and knee
upholstery
Gas spring for adjustable leg supports
Calf support bracket upholstery, pair
Foot fixation, pair
0,-
175,49,132,-
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 2 of 7
Version 2017-01 #6
SW 65-75 cm
Bodypoint Ankle huggers
D44863 S
(L: 17-20 cm)
D44864 M (L: 19-23 cm)
D44865 L
(L: 22-29 cm)
D44904 XL (L: 28-33 cm)
213,213,223,244,-
ARM SUPPORTS AND ACCESSORIES
Standard
Standard
Standard
D21014
D21015
D21078
D21079
D21927
D23003
D41650
D22185
D22186
Arm supports height and depth adjustable with skirt guard in aluminium
(length 39,5 cm)
Arm pads 420 x 80 mm
Reinforced arm support brackets
Arm supports extended with 5 cm (44,5 cm)
Arm supports extended with 10 cm (49,5 cm)
Arm pads 445 x 70 mm
Arm pads 525 x 80 mm
Arm pads curved at the back 525 x 80 mm
Hemiplegic cushion
Arm pad upholstery extra soft (for arm pads 420 x 80 mm) – 3D cover
(not to be combined with a tray)
Arm support hemiplegic left
(not to be combined with a tray)
Arm support hemiplegic left
(not to be combined with a tray)
0,0,0,464,464,112,112,148,123,196,296,296,-
WHEELS
Standard
Standard
X21035
Main wheels 24 x 1 3/8” HD flexel
Reinforced Fork with front wheels: 8" – 200 x 50 flexel
Main wheels 12 ½” with DB flexel
0,0,345,-
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 3 of 7
Version 2017-01 #6
SW 65-75 cm
HEAD SUPPORTS & ACCESSORIES
Standard
D20575
D82566
D20574
D20573
D20576
D27575
D27576
D21027
D21028
D21054
D23004
D23012
D23013
D23015
A
B
C
D
E
Stabilizer for head support
Head support A, with side support
Head support A with side support and head band
Head support B, small, oval
Head support C, large, square
Head support D, comfort (pressure distributive)
Head support E with adjustable side supports
Head support F with cheek support
Head support adjustment tube (horizontal) + 10 cm, length 25 cm
Head support adjustment tube (horizontal) + 23 cm, length 38 cm
Head support adjustment tube (vertical) + 10 cm, length 50 cm
Comfort cushion for head support type C – removable with Mars cover
Easy Care cover for head support type A, B, C – removable
3D cover for head support type A, B, C – removable
Grey head support cushion with Mars cover
F
0,210,255,210,210,268,434,434,79,89,79,162,79,79,214,-
X21060
X21061
D21052
Universal tray for SW 65-70 cm
Universal tray for SW 75 cm
Upholstery for tray
529,639,113,-
TRAYS
VARIOUS ACCESSORIES
D21087
D21239
D41987
D42269
Clinic-Kit (tools and star wheels)
Tool kit
Intravenous rack
Wheelchair bag
106,89,140,298,-
BELT OPTIONS FROM BODYPOINT AND NETTI
Belts and accessories for seat unit
[A]
[B]
D86282
Belt bracket kit – seat [A]
98,-
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 4 of 7
Version 2017-01 #6
SW 65-75 cm
X20845
Hip belt, with upholstery and car belt lock [B]
350,-
Belts and accessories for back unit
[A]
D86890
D20881
D41645
D86895
D86896
D86895
D86896
[B]
[C]
[D]
[E]
H-harness adaptor kit (recommended for all upper body harnesses)
[A]
H-belt, with upholstery and car belt lock [B]
Belt cross harness [C]
Bodypoint Stayflex chest support without zipper [D]
M (Shoulder width 33-41 cm)
L
(Shoulder width 41-48 cm)
Bodypoint Pivofit shoulder harness [E]
M (Shoulder width 33-41 cm)
L
(Shoulder width 41-48 cm)
250,175,175,246,-
246,-
NETTI CUSTOMIZED
Netti has many years of experience in developing customized solutions. Feel free to contact us for a quote
concerning your individual solution.
CUSTOM MADE – most wanted special adapted items (price on request)
Reinforced foot plates, aluminium
Extra-long calf supports (please state length)
Back cushion with special side support
Please describe your current case and how a possible solution could look. If you have any picture or video
material, we would also like to see this. To offer the best solution, please describe the user in the best
possible way, e.g. such as any given diagnosis, user weight and/or the exact pattern movement of the user.
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 5 of 7
Version 2017-01 #6
SW 65-75 cm
Please write the exact measurements and draw the wished solution for the requested accessories e.g. by
using the drawings underneath.
Please inform us if there are any special circumstances in the living area that has an influence for the chair:
e.g. the total possible width _______ cm and length ______ cm of the chair.
TECHNICAL DATA
Tilt (seat)
Recline (back)
Total width of the wheelchair
Total length
Total height
Distance arm support to seatplate
Weight of wheelchair
Frame colour
Cover variants
-9° to +16° with double gas spring
86° to 133° with double gas spring
Seat width + 22 cm (std. wheels/DB-wheels) / +19 cm (12‘‘ DB-wheels)
102 cm with leg rests
105 cm
Min: 18,5 cm/ max. 32,5 cm
App. 36 kg (without cushion)
Silver
3D Cover
Seat height – WITHOUT seat cushion (measured from floor to seat plate)
Main wheel
Seat height/ front wheel
Leg rests
Manual adjustable leg rests
12 1/2“
48,5 cm
24“
8‘‘
Min. calf length
32 cm
47,5 cm
8‘‘
Max. calf length
68 cm
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 6 of 7
Version 2017-01 #6
SW 65-75 cm
Measurements
A Hip width/Seat width
___________ cm
B Thigh length / seat depth
___________ cm
C Arm rest height
___________ cm
D Leg length / seat height
___________ cm
E Backrest height
___________ cm
F Trunk width
___________ cm
NORWAY: Alu Rehab AS | Bedriftsveien 23 | N-4353 Klepp stasjon | [email protected] | Phone +47 51 78 62 20
DENMARK: Alu Rehab ApS | Kløftehøj 8 | DK-8680 Ry | [email protected] | Phone +45 87887300
All prices are list prices excl. VAT| Right for changes reserved | Valid until a new pricelist is published | Page 7 of 7
Version 2017-01 #6