Upload File

victory 10 lx order form - pride mobility · victory® 10 lx - 4 wheel scooter, ... weather cover...

  • Home
  • Documents
  • Victory 10 LX Order Form - Pride Mobility · Victory® 10 LX - 4 Wheel Scooter, ... Weather Cover ..... $202 Part: ACCCOVR1018 Saddle Bag (12.5" x 9.875 ... Victory 10 LX Order Form
2
Page 1 of 2 INFINFB3701/RevE/01OCT2017 Victory ® 10 LX - 4 Wheel Scooter, Quick Ship Order Form Pride ® Mobility Products Corporation 182 Susquehanna Ave Exeter, PA 18643 Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected] Account Number: ___________ Date: ________________ Provider Name: __________________________________ Contact: ________________________________________ Phone: ___________________ Fax: _________________ Email:__________________________________________ PO Number:_____________________________________ Marked for: _____________________________________ Ship to Address: _________________________________ City: _____________________ State: ______ Zip: ______ Black Vinyl, High Back, 18"W x 18"D. ..................... Standard With Sliders Part: SET147133 Black Vinyl, High Back, 22"W x 18"D............................. $350 Without Sliders Part: SET151622 SEATING REQUIRED. Select one seat. COLOR REQUIRED. Colors shown here may differ from actual product depending on monitor/printer calibration used. Candy Apple Red Part: DGN154334 True Blue Part: DGN154333 MODEL REQUIRED. 400 lb. weight capacity. More details and specifications at found at pridemobility.com/scooters. Victory 10 LX with CTS Suspension. ............................................................................................................................................. $2,899 Part: S710LX. HCPCS: K0899, Power mobility device, not coded by DME PDAC or does not meets criteria Includes standard options: • Two 40 Ah AGM batteries • 5-AMP Off-board charger • Light Package • Front Basket • Rear View Mirror ACCESSORIES Optional. 4-Wheel, Black, Weather Cover ....................................... $202 Part: ACCCOVR1018 Saddle Bag (12.5" x 9.875") ................................................ $35 Part: DWR1020D010 Safety Flag ............................................................................ $38 Part: ACCASMB2079 Cup Holder, Style-B (Used on 22" W Seats)..................... $20 Part: ACCASMB2287 Cup Holder, Style-D (Used on 18" W Seats)..................... $20 Part: ACC120041 Rear View Mirror .................................................................. $25 Part: LGTRMIR1003 Cell Phone Holder .................................................................$70 Part: ACC145549 This form is interactive when viewed in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete scooter. Please contact technical service for accurate parts ordering. Thank you for choosing Pride Mobility Products! INTRODUCTION

Upload: dangkhue

Post on 22-Jun-2018

214 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: Victory 10 LX Order Form - Pride Mobility · Victory® 10 LX - 4 Wheel Scooter, ... Weather Cover ..... $202 Part: ACCCOVR1018 Saddle Bag (12.5" x 9.875 ... Victory 10 LX Order Form

Page 1 of 2INFINFB3701/RevE/01OCT2017

Victory® 10 LX - 4 Wheel Scooter, Quick Ship Order Form

Pride® Mobility Products Corporation182 Susquehanna Ave Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

Black Vinyl, High Back, 18"W x 18"D. ..................... StandardWith SlidersPart: SET147133

Black Vinyl, High Back, 22"W x 18"D ............................. $350Without SlidersPart: SET151622

SEATINGREQUIRED. Select one seat.

COLORREQUIRED. Colors shown here may differ from actual product depending on monitor/printer calibration used.

Candy Apple RedPart: DGN154334

True BluePart: DGN154333

MODELREQUIRED. 400 lb. weight capacity. More details and specifications at found at pridemobility.com/scooters.

Victory 10 LX with CTS Suspension. ............................................................................................................................................. $2,899Part: S710LX. HCPCS: K0899, Power mobility device, not coded by DME PDAC or does not meets criteria

Includes standard options:• Two 40 Ah AGM batteries• 5-AMP Off-board charger• Light Package• Front Basket• Rear View Mirror

ACCESSORIESOptional.

4-Wheel, Black, Weather Cover ....................................... $202Part: ACCCOVR1018

Saddle Bag (12.5" x 9.875") ................................................ $35Part: DWR1020D010

Safety Flag ............................................................................ $38Part: ACCASMB2079

Cup Holder, Style-B (Used on 22" W Seats)..................... $20Part: ACCASMB2287

Cup Holder, Style-D (Used on 18" W Seats) ..................... $20Part: ACC120041

Rear View Mirror .................................................................. $25Part: LGTRMIR1003

Cell Phone Holder .................................................................$70Part: ACC145549

This form is interactive when viewed in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete scooter. Please contact technical service for accurate parts ordering.

Thank you for choosing Pride Mobility Products!

INTRODUCTION

http://www.pridemobility.com/scooters/victory10lxwithctssuspension.asp
https://get.adobe.com/reader/
Page 2: Victory 10 LX Order Form - Pride Mobility · Victory® 10 LX - 4 Wheel Scooter, ... Weather Cover ..... $202 Part: ACCCOVR1018 Saddle Bag (12.5" x 9.875 ... Victory 10 LX Order Form

Air Force Patch ............................... $20Part: ACC140240

Army Patch ..................................... $20Part: ACC140241

Coast Guard Patch ........................ $20Part: ACC140239

Marines Patch ................................. $20Part: ACC140243

Navy Patch ...................................... $20Part: ACC140244

Purple Heart Patch ........................ $20Part: ACC140238

Page 2 of 2INFINFB3701/RevE/01OCT2017

Pride® Mobility Products Corporation182 Susquehanna Ave Exeter, PA 18643Phone: 800-800-8586 | Fax: 800-800-1636 | Email: [email protected]

Mobility Made Easy. Pride offers a variety of lifts to transport your mobility product with ease. To find a compatible lift for your vehicle and mobility product, use our new Lift Finder applica-tion at pridemobility.com/lift-finder

Account Number: ___________ Date: ________________ Marked for: _____________________________________

CANE/CRUTCH HOLDEROptional. Only one cane/crutch holder can be used at a time.

COMMENTS

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

BRANCH PATCHESOptional.

Air Force Patch ............................... $20Part: ACC140240

Army Patch ..................................... $20Part: ACC140241

Coast Guard Patch ........................ $20Part: ACC140239

Marines Patch ................................. $20Part: ACC140243

Navy Patch ...................................... $20Part: ACC140244

Purple Heart Patch ........................ $20Part: ACC140238

LAP BELTSOptional.

© 2017 Pride Mobility Products Corp. All rights reserved.

youtube.com/pridemobility

facebook.com/PrideMobilityProductsCorp

twitter.com/pridemobility

instagram.com/PrideMobilityProducts

Wishbone Crutch Holder .................................................... $98Part: FRMASMB2358

Quad Cane Holder ............................................................... $98Part: ACCASMB1931

Single Rear Mount, 3" ..........................................................$70Part: ACCINDV1058

Double Rear Mount, 3" .........................................................$70Part: ACCINDV1019

50" Lap Belt ...............................$39.90 Part: ACCBELT1000

60" Lap Belt ...............................$39.90 Part: ACCBELT1002

70" Lap Belt ...............................$39.90 Part: ACCBELT1003

ACCESSORIES Continued

Back Mounted Accessories

Rear Basket (15.25" x 9.75" x 9.5") .................................... $80 Part: ACCBSKT1010

Oxygen Holder ..................................................................... $98Part: ACCASMB1017

Walker Holder ....................................................................... $98Part: ACCASMB1018

Optional. Only one back mounted accessory can be used at a time. Includes mounting bracket and hardware.

http://www.pridemobility.com/lift-finder/
http://pridemobility.com/lift-finder
https://www.youtube.com/user/PrideMobility
https://www.facebook.com/PrideMobilityProductsCorp
https://www.twitter.com/PrideMobility
https://www.instagram.com/pridemobilityproducts/

LX LX Levelling elements INOX RoHS PA SBR … · LX Levelling elements LX LX-S Code Description Code Description D d L L1 l l1 ... 431039 LX.40-SW17-M8x70 431039-S LX.40-SW17-M8x72-S

LX-80 II - Titan Tool...LX-80 II

LX-260TE 1 Visiomed - LX-260TE - 032017 Visiomed - LX-260TE - … · 2020-04-17 · 1 Visiomed - LX-260TE - 032017 Visiomed - LX-260TE - 032017 1 LX-260TE 0197 Made in China Visiomed

Lighting News 2015 Part 2 - Burcridge News 2015 Part 2.pdf · 3244 lx 130 lx 0,5m 2,5m 1,5m ø 1120 ø 2240 811 lx 2,0m 203 lx 1,0m 360 lx xw ww nw 3612 lx 144 lx 903 lx 226 lx 401

Victory LX 2-leg - ESI

Victory LX Sport Order Form - Pride Mobility Products Corp. · 2020-02-21 · Part: S710LXW. HCPCS: K0899, Power mobility device, not coded INFINFB3823RevA03FEB2020 Page 1 of 2 Victory®

Vertex lx 2315, lx-2316, lx-2325, lx-2231 b

Brochure for 2018 LX - Lexus2. 3 The 2018 LX LX shown in Atomic Silver // Options shown. LX 570 The 2018 LX features a 5.7-liter naturally aspirated V8 engine . with 383 horsepower,

820 LX / 910 LX / 1300 LX USER MANUAL - Wolflabs...820 LX / 910 LX / 1300 LX washers-dryers belongs to the LABEXIA range of washer-driers for the cleaning and drying of labware in

GAS P100/MCE-LX - GAS P150/MCE-LX · GAS BURNERS LOW NOX TWO STAGES PROGRESSIVE OR MODULATING SK073040_C_en GAS P100/MCE-LX - GAS P150/MCE-LX TECHNICAL DATA GAS P100/MCE-LX - GAS

Features - voltaconsolar.com file8289 Lx E Max. 12609 Lx Diameter 133 cm 2.0M 1876 Lx 2644 Lx 267 cm 3.0M 809 Lx 1113 Lx 400 cm 4.0M 449 Lx 610 Lx 534 cm 5.0M 284 Lx 382

LX-5600 2-sheet dot matrix printer LX-5700 2-sheet thermal ...LX-5000 series 02 type LX-5600 2-sheet dot matrix printer LX-5700 2-sheet thermal printer LX-5750 1-sheet thermal printer

2010 journal S- 107 - Western North Carolina Conference journal S- 125. GCFA 300583 300914 300801 301018 968624 968134 301576 300878 ... LX-610. LX-620. LX-630. LX-640. LX-650. 2.c

Model LX Series S1-THSU32P7 S1-THSU32HP7 …source1thermostats.com/documents/lx/LX Residential Owner's and...OwnerOwner’’s Manuals Manual Digital Thermostat LX Series Digital Thermostat

Brochure for the 2019 LX - Lexus · MY19 LX Brochure Job Number: LEXLX-P93479 MY19 LX Brochure 2 LX 570 The 2019 LX features a 5.7-liter naturally aspirated V8 engine with 383 horsepower,

102.3° · 5512 lx 1378 lx 612 lx 345 lx 220 lx 153 lx 112 lx 86 lx 68 lx 55 lx 46 lx 38 lx 33 lx 28 lx 24 lx 22 lx 19 lx 17 lx 15 lx 14 lx 512.1 fc d 128 fcd 56.9 fcd 32 fcd 20.5

LX/A80D, LX/A70D, LX/A70N, LX/A65N, LX/A50D, LX/A50N ...LX/A80D, LX/A70D, LX/A70N, LX/A65N, LX/A50D, LX/A50N, LX/A45N F M V 取 扱 ガ イ ド B5FJ-7071-02 始め方 FMV画面で見るマニュアル

Features - GlacialLight · Features Indoor use ... 2.0M 65 Lx 143 Lx 610 cm 3.0M 28 Lx 62 Lx 915 cm 4.0M 16 Lx 34 Lx 1220 cm 5.0M 10 Lx 21 Lx 1525 cm Outline

LX 2001, LX 2002, LX 2003, LX 2004, LX 2005, LX 2000 … - LX Series...LX 2001, LX 2002, LX 2003, LX 2004, LX 2005, LX 2000 Center LX 2001 LX 2002 LX 2003 LX 2004 LX 2005 LX 2000 Center

LX-NZ3 - 株式会社JVCケンウッドModel Number: LX-NZ3BG, LX-NZ3WG, LX-NZ3BK, LX-NZ3WK Trade Name: JVC Responsible party: JVCKENWOOD USA Corporation Address: 500 Valley Road,

LX-140 / LX-140BL Operating Instructions · LX-140 / LX-140BL Operating Instructions ... NET WEIGHT 82 Lbs OPERATING TEMPERATURE COOLING 60.8℉-107.6℉ HEATING 23℉-89.6℉ DIMENSIONS

BigKeys LX

with flood lamps and spot lamps from Bosch · 30 lx 15 lx 10 lx 5 lx 1 lx m 0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 m 30 lx 15 lx 10 lx 5 lx 1 lx m 0 5 10 15 20 25 30

Symmetra LX Operations Guide - - APC USA LX Rack-mount UPS Symmetra LX Tower UPS Symmetra LX Rack-mount Extended Run Symmetra LX Tower Extended Run Symmetra LX Operations Guide ®

Brochure for 2018 Lexus LX - Auto-Brochures.com LX_2018.pdf · The 2018 LX LX shown in Atomic Silver // Options shown. LX 570 The 2018 LX features a 5.7-liter naturally aspirated

ADVERTISING GUIDE 2020 · 3.562 x 9.875 1/2 PAGE VERT. 7.25 x 4.75 1/2 PAGE 1/3 PAGE HORIZONTAL 2.375 x 9.875 1/3 PAGE VERT. 4.75 x 4.75 SQUARE 3.562 x 4.75 1/4 PAGE Sending Your

GlacialLight CoB LED Natural Sunlight GL-FL35-NL · 3.0M 57 Lx 103 Lx 1039 cm 4.0M 31 Lx 58 Lx 1386 cm 5.0M 20 Lx 36 Lx 1732 cm GL‐FL35‐NL‐

AT-A14 AT-A15/SX, LX AT-A22/SX, LX AT-A24/SX, LX · 2018. 8. 23. · AT-A14 AT-A15/SX, LX AT-A22/SX, LX AT-A24/SX, LX 1000Base Expansion Modules Quick Install Guide PN 613-50133-00

ADVERTISING GUIDE 2020 - DHI · Kathy Sveen at 312.673.5635 or [email protected]. 15.70 x 9.875 15.70 x 4.75 7.375 x 9.875 4.75 x 9.875 DOOR SECURITY + SAFETY NET RATES & SPECIFICATIONS

Dominion LX - Raritan Inc.support.raritan.com/Dominion-LX/version-2.5.5/user-guides/lx-v2-5... · Dominion LX User Guide Release 2 ... LX Overview ... 202 Configuring LX Local Console

by Beghelli · pg6 LX-352 pg7 LX-362 pg8 LX-765 pg9 LX-106 pg10 LX-109 pg11 LX-023 pg12 LX-301 pg13 LX-302 pg14 LX-303 WA pg15 LX-304 LED SURFACE MOUNT LIGHTING . Beghelli Luxnet

Victory LX - ESI

18.8° · 6887 lx 1722 lx 765 lx 430 lx 275 lx 191 lx 141 lx 108 lx 85 lx 69 lx 57 lx 48 lx 41 lx 35 lx 31 lx 27 lx 24 lx 21 lx 19 lx 17 lx 639.8 fc d 160 fcd 71.1 fcd 40 fcd 25.6

LX-5600 2-sheet dot matrix printer LX-5700 2-sheet thermal ... · LX-5600 2-sheet dot matrix printer LX-5700 2-sheet thermal printer LX-5750 1-sheet thermal printer Operation / Manual

Desktop computing engineered around you. · LINUX UD2 LX UD3 LX UD5 LX UD9 LX UD9 LX Touch UD10 LX UD10 LX Touch UNIVERSAL DESKTOP (UD) WES 7 UD3 W7 UD5 W7 UD9 W7 UD9 W7 Touch UD10