Silhouette Order Form, 2 1 15, Excel V2.0 SL10S 06 023rev0215
User Manual: SL10S
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PinDot Series Silhouette
Order Form
Attn: ContourU, 899 Cleveland St. Elyria, OH 44036
For Skribbl'r Digitizing Systems: E-mail Order Form and Digitized File to:
*Required Information to Process this order
Sensor Serial Numbers:
Seat Sensor #:
Back Sensor #:
Back Location Pointer Value
Strap Back
Sensor Back
Seat Data Form #:
Back Data Form #:
Is This Order Going "WITH CHAIR " (NEW Invacare Chair) *
Is This Order Going "ON CHAIR " (NEW Invacare Chair) *
Invacare quote # :
Is This Order Going "ON CHAIR " (NEW Freedom Designs Chair) **
** If a Freedom Designs chair quote is to be converted please contact Freedom Designs
customer service at 1-800-331-8551. Freedom Designs quote/PO # :
AR20 Desk Length Armrest (Pair) SB05 ContourU Pelvic Strap
AR24 Full Length Armrest (Pair) SLK00** Straight Lateral (Right or Left)
LB07 Small Footrest (Pair) SLK05** 1/2" Offset Lateral (Right or Left)
LB08 Large Footrest (Pair) SLK10** 1" Offset Lateral (Right or Left)
LT06 Legrest Tops (Pair) SLK15** 1.5" Offset Lateral (Right or Left)
TR40L Tray Receptacle - Left SL10S Lateral Insert Replacement Set
TR40R Tray Receptacle - Right PDSLM Mulit-Bar Swingaway Lateral - Medium (Pair)
HR15 Headrest Adapter Plate PDSLL Mulit-Bar Swingaway Lateral - Large (Pair)
* HR15 Required when using Contour U pan ** Laterals Fit the Silhouette KwikFit Shell Only
Comments and Special Instructions
When ordering cushions "With Chair" / "On Chair" fax this order form and the order
form for the Invacare Chair to: Pindot Customer Service at 1-800-834-4153
Frame Depth:
Seat to Back
Angle:
Seat to Back
Gap:
Pricing Rev. 2/1/15
Form Rev. 6/4/14
$250.00
$250.00
$235.00
$235.00
Mobility Base Information
Brand: Model:
Frame Width:
$125.00
$290.00$45.00
$140.00
Client Reference: *Purchase Order #:
*Account #:
For ease of ordering, contact Pindot Customer Service Toll Free
at: 800-451-3553 Fax: 800-834-4153
Company Name:
ElyriaCustomSeating@invacare.com
Date:
*City/State/Zip: Cell Phone Number:
*Contact Name: E-mail Address:
Phone Number:
*Ship To Address:
Fax Number:
$235.00
$140.00
$45.00
$125.00
$125.00
$290.00
$125.00
$275.00
Cu stom Sea t in g
Seat Cushion Specifications
Cushion Width:
inches (variable from 8" to 24")
Seat cushion 21" or greater, additional cost applies - see SO80 on price list
Cushion Length:
inches (variable from 8" to 24")
Seat cushion 21" or greater, additional cost applies - SO80
Measured from the back of the digitizer to the place on the client's thigh where you want the cushion to end, plus and additional 1"
Foam Type Removable Covers
PLRTK Polartek
LYCRA Lycra
Extra Firm DARLEX Darlexx
DT-2 Standard Dartex
Mounting DT-2R Reversed Dartex
TFEP To Fit Existing Pan: W x D L-05 Black Rubber Backed Lycra
TFNP New CU Pan Width x Depth L-06 Grey Rubber Backed Lycra
CM06T Wood Mount with T-nuts L-13 Light Blue Rubber Backed Lycra
CM06 Wood Mount without T-nuts L-14 Red Rubber Backed Lycra
****If selecting Wood Mount specify Cover Type**** L-15 Teal Rubber Backed Lycra
Cover Type Draw String Cover L-18 Purple Rubber Backed Lycra
Cover Type Zippered Cover L-19 Burgundy Rubber Baacked Lycra
Cover Type 2-Piece Velcro Cover ** L-20 Blue Rubber Backed Lycra
IDB/SM Infinity Drop Base 14" - 16" wide L-23 Green Rubber Backed Lycra
IDB/MD Infinity Drop Base 17" - 19" wide L-24 Spacer Mesh
IDB/LR Infinity Drop Base 20" - 22" wide Additional Removable Covers
Other SO25 Additional Cover Fabric:
** 2 -piece cover not available if undercut selected SO40 Inner Cover (Recovery)
Unless otherwise specified Seat Cushion will have
Flat Bottom and Hook and Loop Velcro Mount and 4" Curved Rear
Mounting Hardware
HWPMK01 Pan Mounting Kit - 1 inch HWWMK78 Wood Mounting Kit - 7/8 inch
HWPMK78 Pan Mounting Kit - 7/8 inch OCMK01 J & L Brackets - 1 inch (rail cut only)
HWWMK01 Wood Mounting Kit - 1 inch OCMK78 J & L Brackets - 7/8 inch (rail cut only)
FDI-538 Econo-Eze (includes seat & back hardware)*
* Wood mount required
Seat Cushion Modifications
SO90 Leg Length Discrepancy SO77 Undercut
Shorten Left Leg by inches SO92 Solid Wood Insert (sling reduction)
Shorten Right Leg by inches CM30G Recess with Gel Insert*
Longer Leg will be the indicated cushion length CM30 Recess Only* Qty:
SO16 Growth Style 1 inch or 2 inch Depth:
Length= " + Growth " = Total Length "CM09 Soft Spot - Std Foam* Qty:
SO70 Railcut to " Width x "Depth 1 inch or 2 inch Depth:
SO74 Railcut to Contour U Pan CM09V Soft Spot - Visco Foam* Qty:
SO73 Railcut to Infinity Drop Base 1 inch or 2 inch Depth:
VF05 Visco Foam Overlay 1/2"
* Specify size & location in comment section
Comments and Special Instructions
$110.00
VH02 Vent Holes $150.00
$75.00
$75.00
$75.00
$75.00
$240.00
$75.00
Soft
$291.00
$215.00
$240.00
$205.00
$205.00
$205.00
Firm
$150.00
$75.00
$215.00
$971.00
$210.00
$210.00
$205.00
$275.00
$175.00
$175.00
$105.00
$637.00
$75.00
$70.00
$235.00
$165.00
$275.00
When
opting a
2 - tone
fabric
selection
must be
indicated
as "A" for
contact
surface,
"B" for
non -
contact
surface
Back Cushion Specifications
Cushion Width: inches (Variable from 8" - 24") CM30 Recess Only* Qty:
Back cushion 21" or greater, additional cost applies - see SO80 on price list 1 inch or 2 inch Depth:
Cushion Height: inches (Variable from 8" - 24") CM09 Soft Spot - Std Foam* Qty:
Back cushion 21" or greater, additional cost applies - SO80 1 inch or 2 inch Depth:
CM09V Soft Spot - Visco Foam* Qty:
Measurement taken from the grid on Back Shape Sensor prior to 1 inch or 2 inch Depth:
filling gap. If no Fill Gap indicated, this will be your overall cushion height VF05 Visco Foam Overlay 1/2"
* Specify size & location in comment section
Foam Type Removable Covers
Soft PLRTK Polartek
Firm LYCRA Lycra
Extra Firm DARLEX Darlexx
DT-2 Standard Dartex
Mounting DT-2R Reversed Dartex
SKF30 KwikFit Mounting for Backs L-05 Black Rubber Backed Lycra
KwikFit Includes: Shell, Angle Adjustable Interfacing Hardware, L-06 Grey Rubber Backed Lycra
Attachment Points for Pindot Headrest, and a custom Sewn Cover L-13 Light Blue Rubber Backed Lycra
L-14 Red Rubber Backed Lycra
L-15 Teal Rubber Backed Lycra
KwickFit Mounting for Backs will fit between the wheelchair canes. L-18 Purple Rubber Backed Lycra
Cushion and Shell will be made 2 1/2" smaller than the wheelchair L-19 Burgundy Rubber Baacked Lycra
width indicated. Standard KwikFit Mounted Back will have a 2" curved top. L-20 Blue Rubber Backed Lycra
TFEP To Fit Existing Pan: W x D L-23 Green Rubber Backed Lycra
TFNP New CU Pan Width x Height L-24 Spacer Mesh
CM06T Wood Mount with T-nuts Additional Removable Covers
CM06 Wood Mount without T-nuts SO15 Additional Cover Fabric:
****If selecting Wood Mount specify Cover Type**** SO40 Inner Cover (Recovery)
Cover Type Draw String Cover
Cover Type Zippered Cover Back Cushion Modifications
Cover Type 2-Piece Velcro Cover ** SO17 Fill Gap
SO62 Tarsys - 1st Generation Sensor Grid + inches = Total Cushion Height
SO63 Tarsys - 2nd Generation SO70 Railcut to: Width x Depth
SO64 Formula - Contoura SO74 Railcut to Contour U Pan
SO65 Formula - Conventional SO78 Railcut to KwikFit
SO66 Personal Back Shell
ELITE Matrix Elite Shell SO76 I-Cut provide measurements below:
Other
****Unless otherwise specified Back Cushion will have Flat Bottom, Inches
Hook and Loop Velcro Mount and 4" Curved Top**** Bottom of Chest Width
Mounting Hardware Cushion to Inches
HWPMK01 Pan Mounting Kit - 1 inch Second Cut
HWPMK78 Pan Mounting Kit - 7/8 inch
HWWMK01 Wood Mounting Kit - 1 inch Inches
HWWMK78 Wood Mounting Kit - 7/8 inch Bottom of Cushion to First Cut
OCMK01 J & L Brackets - 1 inch (rail cut only) Client's Right Client's Left
OCMK78 J & L Brackets - 7/8 inch (rail cut only)
FDI-596 Econo-Eze (Back Hardware Only)
Comments and Special Instructions
HWABK Adjustable Back Mounting Hardware
Invacare Corporation
One Invacare Way
Elyria, OH 44035-4190
USA
800-333-6900 Form No. 06-023 v2.0
$75.00
VH02 Vent Holes
$110.00
$596.00
$260.00
$205.00
$75.00
Wheelchair Frame Width inches (Variable 12" to 24")
$450.00
Call C/S
$215.00
$400.00
$175.00
$205.00
$175.00
$215.00
$150.00
$205.00
$205.00
$502.00
$75.00
$75.00
$75.00
$971.00
$275.00
$105.00
$165.00
$275.00
$75.00
$150.00
$210.00
$210.00
$75.00
$75.00
When
opting a
2 - tone
fabric
selection
must be
indicated
as "A" for
contact
surface, "B"
for non -
contact
surface
