TR40R Silhouette Order Form, 3 11 V1.3
User Manual: TR40R
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PinDot Series Silhouette
Order Form Rev. 3-1-11
Attn: ContourU, 899 Cleveland St. Elyria, OH 44036
For Skribbl'r Digitizing Systems: E-mail Order Form and Digitized File to:
Sensor Serial Numbers: Seat Sensor #: Back Sensor #:
Back Location Pointer Value
Strap Back
Sensor Back
Seat Data Form #: Back Data Form #:
Mobility Base Information / Cushion Dimensions
Seat to Back Angle: degrees
Seat to Back Gap: inches
* When ordering cushions "With Chair" /
"On Chair" fax this order form and the order for
Is This Order Going "With Chair" (NEW Invacare Chair) *
the Invacare Chair to Pindot Customer Service
Is This Order Going "On Chair" (NEW Invacare Chair) *
Is This Order Going "On Chair" (NEW Invacare Chair) * at 1-800-834-4153
If Invacare quote is to be converted to order, please provide Invacare quote #
If Freedom wheelchair order will be shipped to Invacare for install, please give order #
HR01S* Small Headrest includes Adapter Plate TR40L Tray Receptacle - Left
HR02S* Large Headrest includes Adapter Plate
TR40R
Tray Receptacle - Right
HR03S* 2-Step Headrest includes Adapter Plate SB05 ContourU Pelvic Strap
HR04S* Curved Headrest includes Adapter Plate SLK00**
Straight Lateral (Right or Left)
HR15
Headrest Adapter Plate
SLK05** 1/2" Offset Lateral (Right or Left)
AR20 Desk Length Armrest (Pair) SLK10**
1" Offset Lateral (Right or Left)
AR24
Full Length Armrest (Pair)
SLK15** 1.5" Offset Lateral (Right or Left)
LB07 Small Footrest (Pair) SL10S Lateral Insert Replacement Set
LB08 Large Footrest (Pair) PDSLM Mulit-Bar Swingaway Lateral - Medium (Pair)
LT06 Legrest Tops (Pair) 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
$225.00
$225.00
$210.00
$38.00
$128.00
in
Back Tube Diameter:
Seat Cushion Width:
in
Back Cushion Width:
Seat Tube Diameter
in
Inside Rail Width:
in
Inside Back Cane Width:
in
in
$322.00
$322.00
$322.00
$322.00
City/State/Zip:
Client Reference:
Purchase Order #:
Fax Number:
Account #:
Cell Phone Number:
Frame Width:
Brand:
in
Frame Depth:
Model:
For ease of ordering, contact Pindot Customer Service Toll Free
at: 800-451-3553 Fax: 800-834-4153
Company Name:
ElyriaCustomSeating@invacare.com
Date:
Contact Name:
E-mail Address:
Phone Number:
Ship To Address:
in
$210.00
$225.00
$128.00
$40.00
$110.00
$110.00
$110.00
$110.00
$250.00
$260.00
$260.00
Custom Seating
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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
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 HWWMK78 Wood Mounting Kit - 7/8 inch
HWPMK01 Pan Mounting Kit - 1 inch OCMK01 J & L Brackets - 1 inch (rail cut only)
HWPMK78 Pan Mounting Kit - 7/8 inch OCMK78 J & L Brackets - 7/8 inch (rail cut only)
HWWMK01 Wood Mounting Kit - 1 inch
FDI-538 Econo-Eze (Seat & Back Hardware)*
* Not Recommended for Invacare Solara.
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
$65.00
$240.00
$65.00
$291.00
$195.00
$240.00
$65.00
$65.00
$65.00
$65.00
$205.00
$205.00
$205.00
Soft
Firm
Extra Firm
$195.00
$135.00
$735.00
$190.00
$190.00
$205.00
$250.00
$175.00
$175.00
$637.00
$95.00
$150.00
$250.00
$65.00
$60.00
$210.00
When
opting a
2 - tone
fabric
selection
must be
indicated
as "A" for
contact
surface,
"B" for
non -
contact
surface
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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 SO80 on price list 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 Sew 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
Depth
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
SO76 I-Cut provide measurements below:
ELITE Matrix Elite Shell
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-538 Econo-Eze (Seat & Back Hardware)*
Comments and Special Instructions
FDI-596 Econo-Eze (Back Hardware Only)
HWABK Adjustable Back Mounting Hardware
* Not Recommended for Invacare Solara.
Invacare Corporation
One Invacare Way
Elyria, OH 44035-4190
USA
800-333-6900 Form No. 06-023 v1.3
Wheelchair Frame Width
inches (Variable 12" to 24")
$450.00
Call C/S
$195.00
$260.00
$65.00
$400.00
$175.00
$205.00
$596.00
$637.00
$175.00
$205.00
$205.00
$205.00
$502.00
$195.00
$135.00
$65.00
$65.00
$65.00
$735.00
$95.00
$190.00
$65.00
$65.00
$150.00
$250.00
$65.00
$65.00
$190.00
$250.00
When
opting a
2 - tone
fabric
selection
must be
indicated
as "A" for
contact
surface,
"B" for non
-contact
surface