519, J‐Oswald Forest, suite 101 Saint‐Roch‐de‐l'Achigan, QC, Canada J0K 3H0 T.450 588‐6555 1 866 650‐6555 F.450 588‐0200 www.motioncomposites.com
May 1st, 2011
ORDER FORM
User manual:
□ English □ French
Account :
PO :
Ship to :
Vendor :
Name :
Date :
Address :
Ordered by :
City:
Marked for :
Postal Code :
Province : Phone :
Description 1
WMA3QM005 HELIO /WAMC
Ultralight manual folding helio wheelchair (1)
□
$2950
FRAME COLOR Onyx black □ Summit white □ Sapphire blue □ 2 NC Ruby red □ Monster green □ Sunkissed orange □ 3 Custom color HFC1 $200 4 Clear coated 3k carbon fiber HFC2 $450 SEAT WIDTH & DEPTH 5 Seat width 12” □ 13” □ 14” □ 15” □ 16” □ 17” □ 18” □ NC 6 HSW1 Seat width 19” □ 20” □ WAMA $285 7 Seat depth 12” (2) □ 13” (3) □ 14” □ 15” □ 16” □ 17” □ 18” □ NC 8 Seat depth 19” □ 20” □ WAMB HSD1 $215 FRAME SIZE (See drawing at the end of order form) 9 Regular frame NC 10 Extended frame + 1” (4) □ Extended frame + 2” (5) □ NC notes : (3) : Available with Extended frame +1’’ or +2’’ only (1) : Maximum weight limit: 250lbs (4) : Not available with 20’’ seat depth (2) : Available with Extended frame +2’’ only (5) : Not available with 19’’ and 20’’ seat depth STRAIGHT BACK 11 Lightweight carbon fiber back cane NC 12 Select height: 9” – 12” □ 12” – 15” □ 15” – 18” □ 18” – 21” □ Set height to : _____________ (measured from seat sling to top of back upholstery /see drawing at the end of order form)
□ □ □ □ □ □ □ □ □
□
8° BEND BACK 13 Aluminum back cane HBA1 14 Lightweight carbon fiber back cane HBA5 15 Select height: 13½” – 15” □ 15” – 18” □ 18” – 21” □ Set height to : _____________ (measured from seat sling to top of back upholstery /see drawing at the end of order form)
$80 $140
□ □
$236 $296
□ □
NC NC $175
□ □ □
ADJUSTABLE ANGLE BACK 16 Lightweight carbon fiber back cane straight HBA2 17 Lightweight carbon fiber back cane 8° bend HBA6 18 Select height: 12” – 15” □ 15” – 18” □ 18” – 21” □ 19 Select back cane angle: 85° □ 90° □ 95° □ 100° □ 105° □ 110° □ Set height to : _____________ (measured from seat sling to top of back upholstery /see drawing at the end of order form)
PUSH HANDLES 20 Push handles 21 Omit push handle 22 Folding stabilizer bar* (Available with push handles only)
HBA3
*Suggested with 19” or 20” seat width
Page 1 of 5
HELIO_CANADA_V0.10EN
519, J‐Oswald Forest, suite 101 Saint‐Roch‐de‐l'Achigan, QC, Canada J0K 3H0 T.450 588‐6555 1 866 650‐6555 F.450 588‐0200 www.motioncomposites.com
May 1st, 2011
Description SEATING UPHOLSTERY 23 Nylon seat sling 24 Omit seat sling SEATING CUSHION 25 2’’ cushion 26 3’’ cushion 27 Omit cushion BACK UPHOLSTERY 28 Slip on back upholstery 29 Adjustable tension back upholstery 30 Omit back upholstery FLIP BACK ARMREST 31 Desk length 32 Full length Height 33 6” – 8” □ 8” – 10” □ 9½” – 12” □ 12” – 14” □ ‘’T’’ ARMREST 34 Desk length 35 Full length Height 36 6” – 8” □ 8” – 10” □ 9½” – 12” □ 12” – 14” □ SWING AWAY ARMREST Height adjustable 8” ‐ 12” 37 Tubular arm pad 38 Desk length arm pad 39 Rigid side guard FOOTREST 40 60° swing away footrest, 14” – 18” length adjustable 41 70° swing away footrest, 14” – 18” length adjustable 42 90° swing away footrest, 14” – 18” length adjustable 43 Elevating legrest with calf pad, 14” – 18” length adjustable 44 Length modification, less than 14” or over 18” 45 Direct mount (Footplate(s) mounted to the front frame) Set length to :_______________ STUMP SUPPORT Height and angle adjustable 46 Swing away stump support, 8” x 11” left □ right □ FOOTPLATES 47 Standard (Composite) 48 Adjustable angle oversize (Aluminum) 49 One piece adjustable angle flip‐up 50 Length adjustable heel loop 51 Length adjustable toe strap 52 Calf strap 53 Padded calf strap
Page 2 of 5
NC NC
□ □
HSC1 HSC2
$115 $135 NC
□ □ □
WAMD/WAME HBU1 HBU2
NC $162 $‐15
□ □ □
HAR1 HAR2
$348 $348
□ □
HAR3 HAR4
$280 $280
□ □
HAR5 HAR6 HAR7
$250 $250 $190
□ □ □
HFR1 HFR4 HFR2 HFR3
$55 NC NC $404 $65 $35
□ □ □ □ □ □
HFR5
$375
□
HFP1 HFP2 HFP3 HFP4 HFP5
NC $138 $190 NC $76 $36 $58
□ □ □ □ □ □ □
WAMV
WAMK
WAMJ
HELIO_CANADA_V0.10EN
519, J‐Oswald Forest, suite 101 Saint‐Roch‐de‐l'Achigan, QC, Canada J0K 3H0 T.450 588‐6555 1 866 650‐6555 F.450 588‐0200 www.motioncomposites.com
Description CASTERS 54 Composite wheel 55 /w PU tire (1’’ width) 56
3” □ 4” □ 5” □ 6“ □ 7” □ 8” □ 4” x 1 ½” 5” x 1 ½” 6” x 1 ½” 6” x 1 ¼” □ 8” x 1 ¼” □
Composite wheel 1 Soft‐Roll® by Frog Legs
57 58
May 1st, 2011
Pneumatic CASTER OPTIONS 60 Caster pin locks (Available with +1” or +2” Stem bolt only) 61 Frog Legs suspension forks (Not available with caster pin locks) 1 Soft‐Roll® by Frog Legs are casters that absorb vibrations FRONT SEAT‐TO‐FLOOR HEIGHT MATRIX 59
WAMS
HCA1 HCA2 HCA3 HCA4 HCA5
$50 NC $85 $95 $105 $120
□ □ □ □ □ □
HCA6 HCA7
$220 $475
□ □
Circle the desired configuration
Forks 3” 4” 5”
7”
3” caster
4” caster
5” caster
6” caster
7” caster
8” caster
Stem bolt length STD +1” +2”
Stem bolt length STD +1” +2”
Stem bolt length STD +1” +2”
Stem bolt length STD +1” +2”
Stem bolt length STD +1” +2”
Stem bolt length STD +1” +2”
P1
13 ½
14 ½
15 ½
P1 P2 P1 P2 P3 P4 P1 P2 P3 P4 P5
14 14 ½ 14 ¾ 15 ¼ 15 ¾ 17 ¾
15 15 ½ 15 ¾ 16 ¼ 16 ¾ 18 ¾
16 16 ½ 16 ¾ 17 ¼ 17 ¾ 19 ¾
14 ½ 15 15 ¼ 15 ¾ 16 ¼ 17 ¾ 18 ¼
15 ½ 16 16 ¼ 16 ¾ 17 ¼ 18 ¾ 19 ¼
16 ½ 17 17 ¼ 17 ¾ 18 ¼ 19 ¾ 20 ¼
15 ½
16 ½
17 ½
15 ¾ 16 ¼ 16 ¾
16 ¾ 17 ¼ 17 ¾
17 ¾ 18 ¼ 18 ¾
17 ¼ 17 ¾ 18 ¼ 18 ¾
18 ¼ 18 ¾ 19 ¼ 19 ¾
19 ½ 19 ¾ 20 ¼ 20 ¾
16 ¾ 17 ¼ 17 ¼ 17 ¾ 18 ¼ 18 ¾ 19 ¼
17 ¾ 18 ¼ 18 ¼ 18 ¾ 19 ¼ 19 ¾ 20 ¼
REAR WHEELS 62 Mag (Aluminum or plastic coated handrim only) 22” □ 24” □ 63 Spoke 22” □ 24” □ 64 Spinergy Wire® 20” □ 22” □ 24” □ 26” □ 65 Spinergy Spox® 22” □ 24” □ 25” □ 26” □ 66 Spinergy LX® 22” □ 24” □ 25” □ 26” □ TIRES 67 Soft urethane 1 ⅜” 20” □ 22” □ 24” □ 68 Pneumatic 1 ⅜” 20” □ 22” □ 24” □ 25” □ 26” □ 69 Pyramid – hard urethane 1” 22” □ 24” □ 70 Kenda – Ironcap high pressure 1” 20” □ 22” □ 24” □ 25” □ 26” □ 71 Kenda – Kourier high pressure 1 ⅜” 24” □ 26” □ 72 Soft urethane – high performance 1” 24” □ 25” □ REAR SEAT‐TO‐FLOOR HEIGHT
18 ¾ 19 ¼ 19 ¼ 19 ¾ 20 ¼ 20 ¾ 21 ¼
17 ¾ 17 ¾ 18 ¼ 18 ¾ 19 ¼ 19 ¾
18 ¾ 18 ¾ 19 ¼ 19 ¾ 20 ¼ 20 ¾
19 ¾ 19 ¾ 20 ¼ 20 ¾ 21 ¼ 21 ¾
18 ¾ 19 ¼ 19 ¾ 20 ¼
19 ¾ 20 ¼ 20 ¾ 21 ¼
20 ¾ 21 ¼ 21 ¾ 22 ¼
HRW1 HRW2 HRW3 HRW4
$125 NC $275 $800 $900
□ □ □ □ □
HRT1 HRT2 HTR4 HRT3
NC NC $70 $80 $80 $120
□ □ □ □ □ □
Wheel size 20” wheel 22” wheel 24” wheel 25” wheel 26” wheel
Height available ± ¼” 12 ½” to 17” 13 ½” to 18” 14 ½” to 19” 15” to 19 ½” 15 ½” to 20”
Page 3 of 5
Specify desired height: __________
HELIO_CANADA_V0.10EN
519, J‐Oswald Forest, suite 101 Saint‐Roch‐de‐l'Achigan, QC, Canada J0K 3H0 T.450 588‐6555 1 866 650‐6555 F.450 588‐0200 www.motioncomposites.com
May 1st, 2011
Description HANDRIM 73 Aluminum anodized Assembly 74 regular □ narrow □ Plastic coated 75 High friction plastic coated foam 76 Natural Fit – Standard grip (Available with 22” and 24” wheels only) 77 Spinergy Flexrim (Available with Spinergy LX 24” only) 78 Omit handrim
WAMO WAMO
HHR1 HHR2 HHR3 HHR4
□ □ □ □ □ □
NC $130 $200 $320 $550 NC
AXLE 79 80 81
Quick release axle Permanent axle Quad release axle AMPUTEE ADJUSTABLE AXLE PLATE (May interfere with Swing away or Flip back armrest)
WAMU
HAX1
NC NC $150
□ □ □
WAMT
HAX2
$165
□
HCB1
NC NC $120
□ □ □
HWL1 HWL2 HWL3
NC $32 $120 $312
□ □ □ □
HPB1 HPB2 HPB3
$32 $40 $16
□ □ □
HAC1 HAC2 HAC3 HAC4 HAC5 HAC6
$75 $85 $124 $50 $75 $25
□ □ □ □ □ □
WAMU
82
REAR WHEEL CAMBER ANGLE 83 0° camber 84 3° camber 85 6° camber (Not available with amputee axle plate)
WHEEL LOCK 86 Push to lock □ Pull to lock □ 87 6” removable extension handle 88 Grade aid push to lock (Suggested with pneumatic or high pressure tire) 89 Scissor brake
WAMR
POSITIONING BELT 90 Velcro adjustable 91 Auto buckle 92 Hardware for 4 points seatbelts
ACCESSORIES 93 Anti tippers 94 Cane Carrier left □ right □ 95 Spoke guards 96 Footrest neoprene impact guard 97 Seat pouch 98 helio T‐Shirt Small □ Medium □ Large □ X‐Large □ XX‐Large □
WAMP
Transit securement points come standard on every Helio wheelchair
Total
Comments :
Page 4 of 5
HELIO_CANADA_V0.10EN
519, J‐Oswald Forest, suite 101 Saint‐Roch‐de‐l'Achigan, QC, Canada J0K 3H0 T.450 588‐6555 1 866 650‐6555 F.450 588‐0200 www.motioncomposites.com
May 1st, 2011
CENTER OF GRAVITY
Check the desired rear wheel position OR Specify the distance: ______ (Measure from front of back post to the center of axle) AMPUTEE PLATE
FRAME SIZE AVAILABLE
BACK CANE HEIGHT 3” of height adjustment
Extended Frame recommendation • Allows for future growth • Increased stability • Use with seat depth < 17” to permit forward center of gravity adjustment
•
Back upholstery height •
The slip‐on or adjustable tension back upholstery is attached to the push handle offering 3” of height adjustment with increments of ½” Rigid backs are attached to the back cane and the height of the push handle is adjusted independently.
Regular Frame
Extended Frame +1”
Extended Frame +2”
Page 5 of 5
HELIO_CANADA_V0.10EN