Invacare T-5 Price List And Order Form

® ™
Top End T-5 Tennis Elite Chair
Price List and Order Form
For accuracy of ordering, please fax order to Top End at 727-522-1007 or e-mail to TopEndOrders@invacare.com
For questions call 800-532-8677 or 727-522-8677.
To order Literature: 800-828-6282
Provider Name
Account #
Address
Customer Name
Address
□
Ship order to: Provider
KEY MEASUREMENT GUIDELINES PAGES 2 & 3
SWSA Top End T-5 Tennis Elite Aluminum Chair
SWST Top End T-5 Tennis Elite Titanium Chair
1. SEAT WIDTH □14" □14.5" □15" □15.5" □16" □16.5" □17" □17.5"
□18" □18.5" □19" □19.5" □20" □20.5" □21"
TER1 Tapered seat width ......................................... 125.00
Rear Seat Width: _______ Front Seat Width: _______
2. FOOTREST WIDTH: _______ Standard = Seat Width minus (-) 6"
3. FOOTREST HEIGHT: (TOP) TO FLOOR: _______
4. FOOTREST TYPE: Standard: Tubular Footrest (Adjustable Height)
TER86 Adjustable Angle Footplate.................................. 125.00
□ with risers □ 2" □ 4" (for desired Footrest Heights over 5" from floor)
TER87 Recessed Footrest........................................... 150.00
5. FOOTREST OPTIONS:
TER10 Plastic footrest cover (standard footrest only)............. 75.00
TER89 Carbon fiber footrest cover (standard footrest only)... 125.00
TER127 Toe Clips .......................................................... 60.00
6. FRONT FRAME ANGLE: □ 80° □ 85° □ 90° □ 100°
7. SEAT HEIGHT FRONT: □14.5" □15" □15.5" □16" □16.5" □17".
□17.5" □18" □18.5" □19" □19.5" □20" □20.5" □20-7/8" (53cm)
8. SEAT HEIGHT REAR: □14.5" □15" □15.5" □16" □16.5" □17"
□17.5" □18" □18.5" □19" □19.5" □20" □20.5" □20-7/8" (53cm)
TER31 Solid Seat w/ welded rigidizer bars for aluminum..... 175.00
TERTi3 Solid Seat w/ welded rigidizer bars for titanium........ 425.00
9. AXLE POSITION: "CENTER OF GRAVITY" (choose fixed or adj.):
Fixed Axle Position: □ 3" □ 3.5" □ 4" □ 4.5" □ 5" □ 5.5" □ 6" Other ______
Adjustable Center of Gravity Range: □ 2" to 4" □ 3" to 5"(Std.) □ 4" to 6"
(10). CASTER POSITION: (choose 'Front to Wall' or 'Wheel Base')
FRONT TO WALL:
□18" □ 20" □ 22" □ 24" □ 26" Other ______
-OR- WHEEL BASE:
□15" □16" □17" □18" □19" Other ______
11. UPHOLSTERY SEAT DEPTH: □14" □15" □16" □17" □18"
12. EXTRA FRAME DEPTH: Standard = 0": □1" □ 1½" □ 2"
13. CASTER CENTER TO CENTER (refer to notes)
Standard Mount Footrest CtC = Footrest Width plus (+) 6" □ Other_______
Recess Mount Footrest CtC = Seat Width minus (-) 1" □ Other_______
TH
14. ANTI-TIP/5 WHEEL: Choose one: □Fixed or □Omit
TER102 Telescoping .................................................... 200.00
All prices subject to change w/o notice. All prices in U.S. Dollars. All orders F.O.B. Pinellas Park, Florida, USA
Effective July 1, 2006 Revised January 15, 2009
P.O. #
□
Customer
...........$2,625.00
................3,985.00
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For the most current pricing information go to www.topendwheelchair.com.
www.topendwheelchair.com
Date Top End Job Number
Phone #
City State
Email
City State
Order will ship to Provider unless otherwise noted.
15. CAMBER: □ 12° □ 15° □ 18° □ 20° (no other camber available)
16. WHEEL DISTANCE: Standard = Seat Width + 2.5" □ Other ______
17. WHEEL TYPE: Build for: □ Standard or □ Spinergy
18. SUN®PERFORMANCE WHEELS/ OPTIONS:
Rear Wheel Size: □ 24"(540) □ 25"(559) □ 26"(590) □ 700C
TER131 Spinergy SLX (4mm) upgrade (24 spokes) ........... 895.00
Spoke color: (choose one) □ Black □ Yellow □ White □ Red □ Blue
TER67 Spinergy Spox (3mm) upgrade (24 spokes) ......... 695.00
Spoke color: (choose one) □ Black □ Yellow □ White □ Red □ Blue
TER6 Crossed Spoke Upgrade
(not available for Spinergy wheels)................................. 125.00
®
TER101 Kenda
TER76 Titanium axles ................................................ 150.00
19. PUSHRIMS, ANODIZED (Aluminum):
(□ Std. mount) or (□ Close mount □ Cut Tabs)
TER75 Titanium pushrims upgrade ............................ 600.00
TER08 Coated Pushrims............................................. 100.00
20. BACK HEIGHT (choose fixed or adjustable):
Fixed Height: □ 8" □ 8.5" □ 9" □ 9.5" □10" □10.5" □11" □11.5"
□12" □12.5" □13" □13.5" □14" □14.5" □15" □15.5"
Adjustable Height Range:
□ Short 9" to 11"
Fax #
Zip Code
Phone No ________
Zip Code
Tires: □ Red or □ Yellow.................... 75.00
□ Low 11" to 14" □ Med 14" to 18"
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