AADL Quantum Q6 Edge HD With TB3 Power Positioning Order Form 450 lbs. weight capacity

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1 AADL #W592/W991 Quantum Rehab A Division of Pride Mobility Products Corporation 5096 South Service Rd., Beamsville, Ontario, L0R 1B3 Sales: Phone: (888) Fax (866) ACCOUNT INFO * Please always use to access the most current version of this form AADL Quantum Q6 Edge HD With TB3 Power Positioning Order Form 450 lbs. weight capacity Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Date: PO#: Marked For: Ship To: Address: City: Province: Postal Code: Tail Gate Needed: o Yes o No Taken By: SET-TO-SPEC* Please Supply Client Information: Client Height: Client Weight: Mount Hip/Thigh Supports: o Yes o No Mount Lateral Thoracic Supports: o Yes o No Seat to Floor Height (check one): NOTES: Seating System TRU-Balance 3 Tilt or Tilt & Recline TRU-Balance 3 Tilt or Tilt & Recline with HD Lift Seat-To-Floor Heights TRU-Balance 3 Recline TRU-Balance 3 Recline with HD Lift Seat to floor height are +/- 1/8 with 18 W x 18 D with solid tires (add 3/8 for pneumatic tires). Increased widths may increase lowest seat to floor heights. * While every effort will be taken to ensure dimensions will be preset to your specifications prior to shipping variations in options may effect final settings. Revised: September 1, 2016 Page 1 of 6

45 W x 10 D o Bell Footplate DRIVE WHEELS o 14 Solid (pair) o 4 W Solid, Knobby, $400 Extended Traction Tires 1 (pair) o 14 Pneumatic (pair) o 4 W Pneumatic, Knobby, $400 Extended Traction Tires 1

06 D) o No Foot Platform o Custom Foot plate Refer to Custom Footplate Order form for details and pricing o Through Q-Logic 2 EX w/ Lights $835 Not covered by AADL o Q-Logic 2 EX Joystick $620 o

2 All Pricing is MSRP. BASE MODEL EXPANDABLE CONTROLS COLORS MOTOR OPTIONS o Quantum Q6 Edge HD $8,815 Metallic Colors: o Black o Viper Blue o Hammer II BASE MOUNTED FOOT PLATFORM o Base Mounted Foot Platform o 9.45 W x 10 D o Bell Footplate DRIVE WHEELS o 14 Solid (pair) o 4 W Solid, Knobby, $400 Extended Traction Tires 1 (pair) o 14 Pneumatic (pair) o 4 W Pneumatic, Knobby, $400 Extended Traction Tires 1 (pair) Rim Colour Option: o Silver 1. Increases overall base width by 1.5 LED LIGHT PACKAGE (10.12 W, Tapered to 14 W x D) o No Foot Platform o Custom Foot plate Refer to Custom Footplate Order form for details and pricing o Through Q-Logic 2 EX w/ Lights $835 Not covered by AADL o Q-Logic 2 EX Joystick $620 o Q-Logic 2 EX Joystick w/ Lights $620 Required For Use With LED Light Package o Q-Logic EX Stand Alone Joystick $410 oq-logic 2 EX Enhanced Display Kit $1,945 KIT Includes: - Q-Logic EX Enhanced Display - Flexible Gooseneck - Enhanced Display Mounting Bracket All mounting hardware is included in kit. See Specialty Electronics order form for additional mounting options and secondary controls. Bluetooth mouse emulator requires a run plug harness for either static or power seating. Additional fees will apply. o SCIM Module $730 Specialty Control Interface Module Allows use of joystick display for specialty controls. Up to 5 profiles to control drive, seat and auxiliary functions. Excludes sip-n-puff and single switch functions. A switch is required to operate the input device attached to the SCIM module. Includes Accessory bar. ousb Mobile Device Charger 1 Not covered by AADL $185 Please use and attach the Specialty Electronics order form for additional controls and mounting options. Armor Color Options: o Black Soft Touch (Standard color option). o Matching $75 o Non-Matching $75 Specify Colour: 1. Only available with Q-logic Available with NE, NE+ and Q-Logic 2 EX controllers. Can only charge 1 device at a time. A multiplier harness is required with all Static and Tilt only seating systems. The selection of more than 3 modules required an additional multiplier. JOYSTICK HANDLES BATTERY CHARGER o 8 Amp Off-board Charger NON-EXPANDABLE CONTROLS o 75 Amp NE o 75 Amp NE+ 6-Key (For up to 2 Actuators Thru Joystick) o Standard Carrot Handle o Mushroom Handle $55 o T-Bar $90 o Chin Cup $55 o Extended I-Handle $55 o Soft Ball Handle $55 o Medium Ball Handle $55 o 3 Goal Post $55 o 4 Goal Post Handle $55 Revised: September 1, 2016 Page 2 of 6

JOYSTICK MOUNTING BRACKETS SEAT TO FLOOR HEIGHT TRU-BALAE 3 POWER POSITIONING TB3TILT o Tru Balance 3 HD Power Tilt $7,555 55 degree center of gravity (CG) power tilt seating system TB3RECL o Tru

3 JOYSTICK MOUNTING BRACKETS SEAT TO FLOOR HEIGHT TRU-BALAE 3 POWER POSITIONING TB3TILT o Tru Balance 3 HD Power Tilt $7, degree center of gravity (CG) power tilt seating system TB3RECL o Tru Balance 3 HD Power Recline $7, degrees of power recline, Full drive lock-out at 20 degrees TB3TRECL o Tru Balance 3 HD Power $13,125 Tilt & Recline 55 degree center of gravity (CG) power tilt seating system with 175 degrees of power recline, Full drive lock-out at 20 degrees Power Lift Option: SEATING SPECIFICATIONS Seat Width: Seat Depth: 20W o 20 W 20D o 20 D 21W o 21 W 21D o 21 D 22W o 22 W 22D o 22 D 23W o 23 W 23D o 23 D 24W o 24 W 24D o 24 D 25W o 25 W 25D o 25 D 26W o 26 W 27W o 27 W 28W o 28 W 29W o 29 W 30W o 30 W 31W o 31 W 32W o 32 W Seat Width Package: Seat Depth Package: 2024W o 20 W-24 W 1620D o 20 D-25 D 2428W 2832W Comes Standard with a Quick Release, Adjustable-Height Joystick Block o Fixed, Inline 1 o 24 W-28 W o 28 W-32 W o Left o Right o New Style Swing-Away $265 o Inline, Left o Inline, Right o Offset, Left o Offset, Right o Retract4 Swing-Away $345 o Multi-Axis, Fixed $210 o Left o Right o No Joystick Mount 1. Not available with Q-Logic 2 EX Stand Alone Joystick. TB3LIFT o Tru Balance 3 10 Lift 1 Not covered by AADL $3,995 Must be selected in conjunction with TB3 Tilt or TB3 Recline of scissor lift, 1/4 speed inhibit. Requires Q-logic 2 EX. Not available with manual recline back. Weight capacity 400 lbs. Maximum allowable seat size: 24 W x 24 D. Tilt or Tilt/Recline: Recline: STF17 o 18.5 STF16 o 17.5 STF18 o 19.5 STF17 o 18.5 STF19 o 20.5 STF18 o 19.5 BACK OPTIONS o Fixed/Static Back o Quick Release/Flip Forward Back 1 $35 oback Canes 1,2 (-$735) Back Cane Type: o Angle Adjustable o Flip Forward o 1 Endo o 2 Endo Back Cane Height: o 16 H o 17 H o 20 H o 21 H o 24 H o 25 H 1. Only available w/ Tilt only and HD, Removable armrests. 2. Sport backs, Tru Comfort backs, TB3 Armrests and TB3 Recline are N/A with Back canes TILT BACK SPECIFICATIONS To be picked in conjunction with Static or Flip Forward back type above N/A with Back Cane Selection above o Aftermarket Back Interface (16-20 W) o Aftermarket Back Interface (20-24 W) o Sport Back Width: o 20 W o 21 W o 22 W o 24 W o 26 W o 28 W o 30 W o 32 W Height: o 16 H o 17 H o 18 H o 19 H o 20 H o 21 H o 22 H o 23 H o 23 H o 23 H Back Width Package: o 20 W -24 W o 28 W -32 W o 24 W -28 W Revised: September 1, 2016 Page 3 of 6

4 RECLINE BACK SPECIFICATIONS TB3 Recline is N/A with Back Canes ARMRESTS o Aftermarket Back Interface (16-20 W) o TB3 Armrests 1 Standard with Armrest Downpost o Aftermarket Back Interface (20-24 W) o Sport Back Width: o 20 W o 21 W o 22 W o 24 W o 26 W o 28 W o 30 W o 32 W Height: o 19 H o 20 H o 21 H o 22 H o 23 H o 24 H o 25 H o 26 H o 27 H o 28 H Back Width Package: o 20 W -24 W o 28 W -32 W ADDITIONAL BACK OPTIONS Color Shroud Option: o Standard Black o 24 W -28 W MSH o Matching $105 Left Armrest: Right Armrest: ARM812 o 8 H-12 H ARM812 o 8 H-12 H ARM1216 o H ARM1216 o H FL o Full Length FR o Full Length DL o Desk Length DR o Desk Length Set Armrest Height: Set Armrest Height: AH8 o 8 H AH8 o 8 H AH9 o 9 H AH9 o 9 H AH10 o 10 H AH10 o 10 H AH11 o 11 H AH11 o 11 H AH12 o 12 H AH12 o 12 H AH13 o 13 H AH13 o 13 H AH14 o 14 H AH14 o 14 H AH15 o 15 H AH15 o 15 H AH16 o 16 H AH16 o 16 H Armpads: Choose an armpad style and length, then combine the Abbreviated option # s for the full option # S o Straight S o Straight TB3 armrest with straight armpad Desk length armpad 3 W x L Full length armpad 3 W x 14 L FL o Full Length FR o Full Length DL o Desk Length DR o Desk Length 1. May interfere with swing away laterals. o HD, Removable Armrests $130ea. Left Armrest: Right Armrest: ARM812 o 8 H-12 H ARM812 o 8 H-12 H ARM1216 o H ARM1216 o H 2PARMFL o Full Length 2PARMFR o Full Length 2PARMDL o Desk Length 2PARMDR o Desk Length Armpads: Choose an armpad style and length S o Straight S o Straight W o Waterfall W o Waterfall FL o Full Length FR o Full Length DL o Desk Length DR o Desk Length Revised: September 1, 2016 Page 4 of 6

5 POWER POSITIONING ELECTRONICS CENTER MOUNT FOOT PLATFORM Single Actuator Electronics: THRUTOG o Through Toggle Box (Tilt Only) TOGL o Left Mount TOGR o Right Mount THRUJOY o Through NE+ 6 Key THRUJOYSS o Through Q-Logic 2 EX $345 Controller & Single Switch (includes DWR1265H064) THRUJOY o Through Q-Logic 2 EX $345 Controller & Joystick o Through Q-Logic 2 EX $660 Controller & Single Function with 4-Button Actuator (Mounts to same side as joystick) Dual Actuator Electronics: MTHRUJOY o Through NE+ 6-Key Controller $155 MTHRUJOY o Through Q-Logic 2 EX Controller $345 Multiple Actuator Electronics: MTHRUJOY o Through Q-Logic 2 EX $345 Controller o Through Q-Logic 2 EX $660 Controller and Single Function with 4-Button Actuator (Mounts to same side as joystick) MTHRUTOG o Q-Logic 2 EX Through 4-way $660 Toggle TOGL o Left Mount o Right Mount o Q-Logic 2 EX Through 4-way $660 Button Toggle TOGL o Left Mount o Right Mount o Q-Logic 2 EX Through Quad $660 Push Button TOGL o Left Mount o Right Mount NON-POWERED LEGRESTS o HD Drop-In Legrests o HD Elevating Legrests $550 o Angle Adjustable Footplates 1 $175 Extensions: o o Set Legrest LL12 o 12 H LL145 o 14.5 H LL18 o 17 H LL125 o 12.5 H LL15 o 15 H LL185 o 17.5 H LL13 o 13 H LL155 o 15.5 H LL19 o 18 H LL135 o 13.5 H LL16 o 16 H LL14 o 14 H LL165 o 16.5 H o Footplates o 4 W x 6 D o 5 W x 6 D o 5 W x 8 D o 6 W x 8 D o 6 W x 11 D o 8 W x 11 D 1. Angle Adjustable footplates are No Charge when chosen with HD Elevating Legrests o Center Mount Articulating Foot Platform $3,145 Not covered by AADL o 20 W-24 W Adjustable Center Mount Foot Platform $265 o 24 W-32 W Adjustable Center Mount Foot Platform $475 Extensions: o L o L Footplates: o 5 W x 6 D o 5 W x 8 D o 5 W x 11 D Set Legrest LL85 o 8.5 H LL9 o 9 H LL95 o 9.5 H LL10 o 10 H LL135 o 13.5 H LL165 o 16.5 H LL105 o 10.5 H LL14 o 14 H LL17 o 17 H LL11 o 11 H LL145 o 14.5 H LL175 o 17.5 H LL115 o 11.5 H LL15 o 15 H LL18 o 18 H LL12 o 12 H LL155 o 15.5 H LL185 o 18.5 H LL125 o 12.5 H LL16 o 16 H LL19 o 19 H LL13 o 13 H Calf Supports: o Calf Pads (pair) 1 o Small (6 H x 6 W) $210 o Large (8 H x 8 W, tapered to 6 W) $210 o Calf Panel (ea.) o Small (8 H x 18 W) $210 o Large (8 H x 24 W) 2 $265 Calf Support Covers (1/2 Soft Visco Foam): o Air Mesh $150 o Reversed Dartex $150 Optional Extensions & Accessories: o 4 Width Extension Kit 3 $55 o 2 Bell Shaped, Length Extension Kit 4 $55 o Footplate Outside Edge Side Guards $55 o4 D 5 o6 D 3 o Footplate Connector $55 o Wheel Bumpers $30 1. Standard with Articulating Foot Platform 2. Only available on 20 W or greater. 3. Not available with 5 W x 6 D Footplates 4. Not available with 4 Wdith Extension Kit 5. Not available with 5 W x 11 D Footplates Center Mount Articulating Foot Platform Compatability Matrix Revised: September 1, 2016 Page 5 of 6 TRU-Balance 3 Recline TRU-Balance 3 Tilt TRU-Balance 3 Lift Low Medium High Low Medium High Low Medium High Extension!! aaaaa aa Extension!!!!!!!!! a This rigging configuration causes no interference issues at this seat-to-floor height. This rigging configuration may interfere with the ground (less than 1.75 clearance when fully extended)! and will reduce obstacle climbing ability. X This rigging configuration does not work with this seat-to-floor height.

ACCESSORIES Not covered by AADL One of the following items (cup holder, item hook,

Please indicate which no-charge accessory: CUP o Cup Holder $35 Not available w/

Trilogy Vent Tray 1 $420 TB3PUSH o Push Handles (pair) 2 $140 PIH o Personal Item

For use with Trilogy 100 or 200 ventilators.

75 high -- less the mounting brackets. N/A with back cane option. 2.

Kit $35 CELL o Cell Phone/Media Holder 1 $95 Not available w/ 2-post flip back

following accessories will be shipped with the unit, not installed Multiple

OXYGEN o Oxygen Holder $90 Not available w/ back cane option CP250 o Stealth 10

Headrest Mounts: HMO475 o Multi-Axis Hardware $200 TWB485 o Linking Hardware $255 o

with Back Cane option CGUAR o Clothing Guard, Pair $275 BATTERIES o Group 24, 70 Amp

6 ACCESSORIES Not covered by AADL One of the following items (cup holder, item hook, glove box or reflector kit) can be picked at no-charge if purchased on-chair. Please indicate which no-charge accessory: CUP o Cup Holder $35 Not available w/ 2-post flip back armrests PREMIUM INSTALLED ACCESSORIES Not covered by AADL TVENT o Trilogy Vent Tray 1 $420 TB3PUSH o Push Handles (pair) 2 $140 PIH o Personal Item Hook $35 Not available w/ back cane option GBOX o Glove Box $40 1. For use with Trilogy 100 or 200 ventilators. The vent tray dimensions are approximately 7.0 long x 11.5 wide x 9.75 high -- less the mounting brackets. N/A with back cane option. 2. Not available with O2 holder or vent tray. Required with attendant manual recline. N/A with back cane option. STEALTH HEADRESTS (Standard Stealth Pricing Applies) Headrest Pads: RKIT o Reflector Kit $35 CELL o Cell Phone/Media Holder 1 $95 Not available w/ 2-post flip back armrests BPH o Backpack Holder, Pair $45 Not available w/ back cane option The following accessories will be shipped with the unit, not installed Multiple accessories can be mounted along the various tracks, some interference may occur OXYGEN o Oxygen Holder $90 Not available w/ back cane option CP250 o Stealth 10 Comfort Plus $190 CP150 o Stealth 14 Comfort Plus $190 OTSM250 o Stealth Small Contoured $80 (9.75 W x 3 H) OTLG150 o Stealth Large Contoured $100 (11 W x 6 H) o Omit Headrest Headrest Mounts: HMO475 o Multi-Axis Hardware $200 TWB485 o Linking Hardware $255 o No bracket LAPBELTS o 60 o 38 o 50 o 70 o 80 o 90 OXYGEN o Oxygen Holder $90 For use with Back Cane option CGUAR o Clothing Guard, Pair $275 BATTERIES o Group 24, 70 Amp Batteries Installation: o Batteries Installed o Do Not Install $415 ea. QRTB o Transfer Bar, Pair $305 (Quick-Release) o Bolt-on o Quick Release o Accessory Bracket 1 $90 o Quantum Backpack $65 o Tablet Holder Call for Pricing 1. Comes standard with Trilogy vent tray and oxygen holder. May be added to mount additional accessories to back of unit. Revised: September 1, 2016 Page 6 of 6

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight:

Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight: Quantum Rival Group 3 Single Power & Multiple Power With TRU-Balance 3 Order Form 300 lbs. weight capacity Quantum Rehab A Division of Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter,