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Alber USA LLC 1005 International Drive Oakdale

ORDER Invoice address
Company Street City

E35 E36 Plus
Q U O TAT I O N
Customer No. PO No.

ST

ZIP

Standard Optional field Mandatory fields:1)
Shipping address (if different from invoice address)

1

Company Street City

ST

ZIP

Type of order Dealer installation *Pending service dept approval* Installation by Alber USA in factory

$ 45.00

Order marked for

e-fix E35 (260 lbs max.)

Battery pack, 6 Ah (216 Wh)
Standard for E35
Battery pack, 7.5 Ah (270 Wh) (additional charge)

Size of drive wheel

22"

24"

**REQUIRED**
Wheelchair details

Wheelchair manufacturer (ex. Invacare) Model (ex. Myon) Year of construction

Equipped with vehicle retention system

EZ Lock

Tiedown

Amputee axle plate

**DRUM BRAKES MUST BE REMOVED!**

Important hardware
Wheelchair mounting bracket
*Possible additional fee for brackets dependent on chair ­ contact Alber USA with questions*
Anti-tippers with jack-up function
*Not compatible with all wheelchairs ­ contact Alber USA with questions*

Comments (mounting, delivery, etc.)

$ 7,295.00 $ 0.00
$ 300.00

e-fix E36 Plus (350 lbs max.)

Battery pack, 7.5 Ah (270 Wh)
Standard for E36
Battery pack, 6 Ah (216 Wh) (price reduction)

Size of drive wheel

24"

**REQUIRED**

Seat width (seat tube measured on the outside)

Rear seat height

$ 7,895.00 $ 0.00
- $ 300.00
inch inch

$ 0.00 (pair) $ 400.00

Standard control unit mounting

Left (instead of right)

Right

**REQUIRED** Armrest style
Tubular or swing away Desk or full pad style: With transfer loop No user access (if attendant mount)

Without transfer loop

Alber USA LLC 1005 International Drive Oakdale

E35 E36 Plus

Control unit accessories
Swing away arm Protection bumper Attendant mount (for standard controller)

Side: Right Left

Style Push handle Stroller handle

Joystick option
Option special, 40 mm/1.57 inch Option soft, 70 mm/2.76 inch Option T-handle

Standard Optional field
Mandatory fields: The order cannot be processed without details!

$ 495.00 $ 99.00 $ 295.00

Battery accessories
Spare battery, 6.0 Ah (216 Wh) Spare battery, 7.5 Ah (270 Wh) Transport bag for spare battery Attachment set for transport bag Spare battery charger

2
$ 950.00 $ 1,250.00
$ 110.50 $ 38.50 $ 435.00

$ 55.00 $ 55.00 $ 178.00

Spoke covers for drive wheels
Alber logo, 24" Alber logo, 22" Transparent, 24" Transparent, 22"

(pair) $ 252.00 (pair) $ 252.00 (pair) $ 252.00 (pair) $ 252.00

Extension for speed preselection
(larger speed dial)
Extension for speed preselection

$ 76.00

Extension for coupling ring
Set for one drive wheel Set for two drive wheels

$ 205.50 $ 400.50

Remote interface for external devices and controls

Opti-Box (Remote interface) Opti-Box bracket

$ 562.00 $ 154.00

Switches (Opti-Box required)
External on/off switch ­ Buddy button Speed stop/Speed limit switch (need for standing wheelchairs)

$ 203.50 $ 130.00

Intuitive attendant control
Intuitive attendant control unit (Push/Brake aid) Opposing push handle Intuitive control mounting hardware

Side: Right Left

Style: Push handle Stroller handle

$ 995.00 $ 115.00 $ 285.00

External charging socket
External charger socket incl. clip

$ 188.50

Contact Name:

Email:

Date

/

/

Signature of ordering party

As of April, 2017. All prices are subject to the statutory VAT, and include packaging FOB. The General Terms and Conditions of Alber USA LLC shall apply; subject to changes.