TRX BA EED DE - DE INVACARE MATRX ... - Freedom Designs, Inc.freedomdesigns.com/Literature/SP Literature/Matrx... · FREEDOM DESIGNS ON-CHAIR ORDER FORM ... Invacare® Matrx® MX1

INVACARE® MATRX® BACKSUS PRICE LIST/ORDER FORM

Effective November 1st, 2014

1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

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Pediatric Backs 4 Page

Invacare® Matrx® Mini Back/Extra Outer Cover 2

Standard Backs 4 Page

Invacare® Matrx® PB Back/Extra Outer Cover 3Invacare® Matrx® PB Deep Back/Extra Outer Cover 3Invacare® Matrx® Elite Back/Extra Outer Cover 6/7Invacare® Matrx® Elite Full Back/Extra Outer Cover 7Invacare® Matrx® Elite TR Back/Extra Outer Cover 8Invacare® Matrx® Elite Deep Back/Extra Outer Cover 9Hardware Upgrades for Matrx Elite and PB Backs 13/14/15Invacare® Matrx® MX1 Back/Extra Outer Cover 18/19Hardware Upgrades for Matrx MX1 Back 20Invacare® Matrx® Genera Back/Extra Outer Cover 20

Bariatric Backs 4 Page

Invacare® Matrx® PB Heavy‐Duty Back/Extra Outer Cover 4Invacare® Matrx® PB Extra Wide Heavy‐Duty Back/Extra Outer Cover 4Invacare® Matrx® PB Deep Heavy‐Duty Back/Extra Outer Cover 5Invacare® Matrx® PB Extra Wide Deep Heavy‐Duty Back/Extra Outer Cover 5Invacare® Matrx® Elite Deep Heavy‐Duty Back/Extra Outer Cover 10Invacare® Matrx® Elite TR Heavy‐Duty Back/Extra Outer Cover 10Invacare® Matrx® Elite Heavy‐Duty Back/Extra Outer Cover 11Invacare® Matrx® Elite Extra Wide Heavy‐Duty Back/Extra Outer Cover 11Hardware Upgrades for Matrx Elite and PB Backs 13/14/15

Modifications & Accessories 4 Page

Invacare® Matrx® Elite & Mini Back Laterals 12Matrx® PB & Elite Back Options and Modifications 16/17Military Service Emblems 17Headrest Supports & Hardware 21Other Accessories 22

NOTE: ITEMS HIGHLIGHTED IN GREEN ARE AVAILABLE THROUGH MOTION CONCEPTS ONLY

1 of 121 (800) 331-8551 FAX: 1(888) 582-1509 FDMOCB 11.2015 REV. A

INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORM



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Date of Order:______________________________________________

Dealer Name: ______________________________________________

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® INVACARE® MATRX® BACKSFREEDOM DESIGNS ON-CHAIR ORDER FORM




1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

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1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

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1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORMMATRX® MINI BACK: Pediatric – Positioning Back

Mini Back 4 HCPCS E2615

MODEL FITS WIDTH FITS HEIGHT MSRPqMINI1007 10", 11" 7" $625.00qMINI1010 10", 11" 10" $625.00qMINI1012 10", 11" 12" $625.00qMINI1107 11", 12" 7" $625.00qMINI1110 11", 12" 10" $625.00qMINI1112 11", 12" 12" $625.00qMINI1207 12", 13" 7" $625.00qMINI1210 12", 13" 10" $625.00qMINI1212 12", 13" 12" $625.00qMINI1214 12", 13" 14" $625.00qMINI1307 13", 14" 7" $625.00qMINI1310 13", 14" 10" $625.00qMINI1312 13", 14" 12" $625.00qMINI1314 13", 14"" 14" $625.00qMINI1407 14", 15" 7" $625.00qMINI1410 14", 15" 10" $625.00qMINI1412 14", 15" 12" $625.00qMINI1414 14", 15" 14" $625.00COVER OPTIONS:SPECIFY: q MINI‐K (Kid*ab*ra) q MINI‐P (Pink Lollipop) q MINI‐B (Blizzard Blue)

Mini Extra Outer Cover (Comes standard with foam) 4 HCPCS E2619

MODEL FITS WIDTH FITS HEIGHT MSRPMC REFER TO BACK SIZES ABOVE $135.00

SPECIFY: WIDTH_____ HEIGHT_____ q QTY____

COVER OPTIONS:SPECIFY: q MC‐K (Kid*ab*ra) qMC‐P (Pink Lollipop)q MC‐B (Blizzard Blue)

1.888.433.6818 FAX: 1.888.433.6834 2 of 22 TRD0366 REV F

n Standard Kid*ab*ra Fabric upholstery orno charge cover options of Pink Lollipop orBlizzard Blue

n Mini Set Hardware fits ¾", 7/8", 1" diameter back canes

n 3" Contour Depthn Weight capacity up to 150 lbsn Backs are drilled for headrest attachmentn Extra outer cover includes foam

Kid*ab*ra Outer Cover

Pink LollipopOuter Cover

Blizzard BlueOuter Cover

INVACARE® MATRX® BACKS – US PRICE LIST/ORDER FORM



1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORMMATRX® PB BACK: Standard – Positioning Back

PB Back 4 HCPCS Code: E2615

MODEL FITS WIDTH FITS HEIGHT MSRPqMPB1412 13"‐15" 12" $625.00qMPB1416 13"‐15" 16" $625.00qMPB1612 15"‐17" 12" $625.00qMPB1616 15"‐17" 16" $625.00qMPB1620 15"‐17" 20" $625.00qMPB1712 16"‐18" 12" $625.00qMPB1716 16"‐18" 16" $625.00qMPB1720 16"‐18" 20" $625.00qMPB1812 17"‐19" 12" $625.00qMPB1816 17"‐19" 16" $625.00qMPB1820 17"‐19" 20" $625.00qMPB2012 19"‐21" 12" $625.00qMPB2016 19"‐21" 16" $625.00qMPB2020 19"‐21" 20" $625.00

PB Extra Outer Cover 4 HCPCS: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPPBC REFER TO BACK SIZES ABOVE $100.00SPECIFY: WIDTH_____ HEIGHT_____ q QTY____

MATRX® PB DEEP BACK: Standard – Positioning Back

PB Deep Back 4 HCPCS Code: E2615

MODEL FITS WIDTH FITS HEIGHT MSRPq PBD1412 13"‐15" 12" $645.00q PBD1416 13"‐15" 16" $645.00q PBD1612 15"‐17" 12" $645.00q PBD1616 15"‐17" 16" $645.00q PBD1620 15"‐17" 20" $645.00q PBD1712 16"‐18" 12" $645.00q PBD1716 16"‐18" 16" $645.00q PBD1720 16"‐18" 20" $645.00q PBD1812 17"‐19" 12" $645.00q PBD1816 17"‐19" 16" $645.00q PBD1820 17"‐19" 20" $645.00q PBD2012 19"‐21" 12" $645.00q PBD2016 19"‐21" 16" $645.00q PBD2020 19"‐21" 20" $645.00

PB Deep Extra Outer Cover 4 HCPCS: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPPBDC REFER TO BACK SIZES ABOVE $110.00SPECIFY: WIDTH_____ HEIGHT_____ q QTY____


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n Standard Meshtex Fabric upholstery n Easy Set Hardware fits ¾", 7/8", 1" diameter back canes

n See Page 13 for other no-charge hardware options

n 5" Contour Depthn Weight capacity up to 300 lbs n Backs include reinforcement plate for

headrest

n 7" Contour Depth

MeshtexOuter Cover

9 for other no-charge hardware



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Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORMMATRX® ELITE BACK: Standard – Positioning Back

Elite Back 4 HCPCS Code: E2620

MODEL FITS WIDTH FITS HEIGHT MSRPq PBE1210 12"‐13" 10" $625.00q PBE1212 12"‐13" 12" $625.00q PBE1214 12"‐13" 14" $625.00q PBE1216 12"‐13" 16" $625.00q PBE1218 12"‐13" 18" $625.00q PBE1310 13"‐14" 10" $625.00q PBE1312 13"‐14" 12" $625.00q PBE1314 13"‐14" 14" $625.00q PBE1316 13"‐14" 16" $625.00q PBE1318 13"‐14" 18" $625.00q PBE1410 14"‐15" 10" $625.00q PBE1412 14"‐15" 12" $625.00q PBE1414 14"‐15" 14" $625.00q PBE1416 14"‐15" 16" $625.00q PBE1418 14"‐15" 18" $625.00q PBE1420 14"‐15" 20" $625.00q PBE1510 15"‐16" 10" $625.00q PBE1512 15"‐16" 12" $625.00q PBE1514 15"‐16" 14" $625.00q PBE1516 15"‐16" 16" $625.00q PBE1518 15"‐16" 18" $625.00q PBE1520 15"‐16" 20" $625.00q PBE1610 16"‐17" 10" $625.00q PBE1612 16"‐17" 12" $625.00q PBE1614 16"‐17" 14" $625.00q PBE1616 16"‐17" 16" $625.00q PBE1618 16"‐17" 18" $625.00q PBE1620 16"‐17" 20" $625.00q PBE1710 17"‐18" 10" $625.00q PBE1712 17"‐18" 12" $625.00q PBE1714 17"‐18" 14" $625.00q PBE1716 17"‐18" 16" $625.00q PBE1718 17"‐18" 18" $625.00q PBE1720 17"‐18" 20" $625.00q PBE1810 18"‐19" 10" $625.00q PBE1812 18"‐19" 12" $625.00q PBE1814 18"‐19" 14" $625.00q PBE1816 18"‐19" 16" $625.00q PBE1818 18"‐19" 18" $625.00q PBE1820 18"‐19" 20" $625.00

More sizes are available on the next page


1.888.433.6818 FAX: 1.888.433.6834 6 of 22 TRD0366 REV F

Standard Meshtex Fabric upholstery n Easy Set Hardware fits ¾", 7/8", 1" diameter back canes


n 3" Contour Depthn Weight capacity up to 300 lbsn All Elite Backs 15" and wider x 14" and

higher are pre-drilled for headrest attachment,and include headrest adapter plate

n Extra outer cover includes foam

MeshtexOuter Cover




1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORMINVACARE® MATRX® BACKS – US PRICE LIST/ORDER FORM

1.888.433.6818 FAX: 1.888.433.6834 7 of 22 TRD0366 REV F

MATRX® ELITE BACK: Standard – Positioning Back

Elite Back Continues 4 HCPCS Code: E2620

MODEL FITS WIDTH FITS HEIGHT MSRPq PBE1910 19"‐20" 10" $625.00q PBE1912 19"‐20" 12" $625.00qPBE1916 19"‐20" 16" $625.00q PBE1918 19"‐20" 18" $625.00q PBE1920 19"‐20" 20" $625.00q PBE2010 20"‐21" 10" $625.00q PBE2012 20"‐21" 12" $625.00q PBE2016 20"‐21" 16" $625.00q PBE2018 20"‐21" 18" $625.00q PBE2020 20"‐21" 20" $625.00

Elite Extra Back Cover (Refer to back sizes for proper fit) 4 HCPCS Code: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPPBEC REFER TO BACK SIZES ABOVE $135.00


Standard Meshtex Fabric upholstery n Easy Set Hardware fits ¾", 7/8", 1" diameter back canes



higher are pre-drilled for headrest attachment, and include headrest adapterplate

n Extra outer cover includes foam

MeshtexOuter Cover

MATRX® ELITE FULL BACK: Standard – Positioning Back

Elite Full BackMODEL FITS WIDTH FITS HEIGHT MSRPq PBE1620‐FB 16"‐17" 20" $625.00q PBE1720‐FB 17"‐18" 20" $625.00q PBE1920‐FB 19"‐20" 20" $625.00

Elite Full Extra Back Cover (Refer to back sizes above for proper fit) 4 HCPCS Code: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPPBEC‐FB REFER TO BACK SIZES ABOVE $135.00




n Back Shell made without scapular cutout andincludes SuperSoft foamn Weight capacity up to 300 lbsn Pre-drilled for headrest attachment, and

includes headrest adapter plate n Extra outer cover includes foam

MeshtexOuter Cover




1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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n Back Shell made without scapular cutout andincludes SuperSoft foam. Recommended forTilt/Recline applications

n 3" Contour Depthn Weight capacity up to 300 lbsn Pre-drilled for headrest attachment,

includes headrest adapter plate n Extra outer cover includes foam

MeshtexOuter Cover

MATRX® ELITE TR BACK: Standard – Positioning Back

Elite TR Back 4 HCPCS Code: E2620

MODEL FITS WIDTH FITS HEIGHT MSRPq PBE1516‐TR 15"‐16" 16" $650.00q PBE1518‐TR 15"‐16" 18" $650.00q PBE1520‐TR 15"‐16" 20" $650.00q PBE1616‐TR 16"‐17" 16" $650.00q PBE1618‐TR 16"‐17" 18" $650.00q PBE1620‐TR 16"‐17" 20" $650.00q PBE1716‐TR 17"‐18" 16" $650.00q PBE1718‐TR 17"‐18" 18" $650.00q PBE1720‐TR 17"‐18" 20" $650.00q PBE1816‐TR 18"‐19" 16" $650.00q PBE1818‐TR 18"‐19" 18" $650.00q PBE1820‐TR 18"‐19" 20" $650.00q PBE1916‐TR 19"‐20" 16" $650.00q PBE1918‐TR 19"‐20" 18" $650.00q PBE1920‐TR 19"‐20" 20" $650.00q PBE2016‐TR 20"‐21" 16" $650.00q PBE2018‐TR 20"‐21" 18" $650.00q PBE2020‐TR 20"‐21" 20" $650.00

Elite TR Extra Back Cover (Refer to back sizes above for proper fit) 4 HCPCS Code: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPPBEC‐TR REFER TO BACK SIZES ABOVE $150.00





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Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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1.888.433.6818 FAX: 1.888.433.6834 9 of 22 TRD0366 REV F

n Extra outer cover includes foam n Standard Meshtex Fabric upholstery

n Easy Set Hardware fits ¾", 7/8", 1" diameter back canes



higher are pre-drilled for headrest attachment, includes headrest adapter plate

MeshtexOuter Cover

MATRX® ELITE DEEP BACK: Standard – Positioning Back

Elite Deep Back 4 HCPCS Code: E2620

MODEL FITS WIDTH FITS HEIGHT MSRPq EDB1412 14"‐15" 12" $760.00q EDB1416 14"‐15" 16" $760.00q EDB1418 14"‐15" 18" $760.00q EDB1420 14"‐15" 20" $760.00q EDB1510 15"‐16" 10" $760.00q EDB1512 15"‐16" 12" $760.00q EDB1514 15"‐16" 14" $760.00q EDB1516 15"‐16" 16" $760.00q EDB1518 15"‐16" 18" $760.00q EDB1520 15"‐16" 20" $760.00q EDB1610 16"‐17" 10" $760.00q EDB1612 16"‐17" 12" $760.00q EDB1614 16"‐17" 14" $760.00q EDB1616 16"‐17" 16" $760.00q EDB1618 16"‐17" 18" $760.00q EDB1620 16"‐17" 20" $760.00q EDB1710 17"‐18" 10" $760.00q EDB1712 17"‐18" 12" $760.00q EDB1714 16"‐17" 14" $760.00q EDB1716 17"‐18" 16" $760.00q EDB1718 17"‐18" 18" $760.00q EDB1720 17"‐18" 20" $760.00q EDB1810 18"‐19" 10" $760.00q EDB1812 18"‐19" 12" $760.00q EDB1814 16"‐17" 14" $760.00q EDB1816 18"‐19" 16" $760.00q EDB1818 18"‐19" 18" $760.00q EDB1820 18"‐19" 20" $760.00q EDB1910 19"‐20" 10" $760.00q EDB1914 19"‐20" 14" $760.00q EDB1616 16"‐17" 16" $760.00q EDB1916 19"‐20" 16" $760.00q EDB1918 19"‐20" 18" $760.00q EDB1920 19"‐20" 20" $760.00q EDB2010 20"‐21" 10" $760.00q EDB2012 20"‐21" 12" $760.00q EDB2014 16"‐17" 14" $760.00q EDB2016 20"‐21" 16" $760.00q EDB2018 20"‐21" 18" $760.00q EDB2020 20"‐21" 20" $760.00

Elite Deep Extra Back Cover (Refer to back sizes above for proper fit) 4 HCPCS Code: E2619

MODEL FITS WIDTH FITS HEIGHT MSRPEDBC REFER TO BACK SIZES ABOVE $150.00





1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

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1.888.433.6818 FAX: 1.888.433.6834 12 of 22 TRD0366 REV E

XS S

M L

L R

L R

MATRX® ELITE LATERALS: Available for Matrx Elite, Elite Deep & Elite Heavy-Duty Backs

Fixed ‐ Available for Matrx Elite, Elite Deep & Elite Heavy‐Duty Backs 4 HCPCS Code: E0956

QUANTITY MODEL DESCRIPTION MSRPq QTY____ PBLS‐L Standard Fixed Hardware‐Left or Right (each) $110.00q QTY____ PBLS‐R Pad 5" High x 7.5" Long q QTY____ PBSS‐L Small Fixed Hardware‐Left or Right (each) $110.00q QTY____ PBSS‐R Pad 3" High x 5.5" Longq QTY____ PBOL‐L Offset Lateral Pad w/Fixed Hardware (each) $110.00 q QTY____ PBOL‐R Pad 5" High x 7.5" Long

Swing‐Away Hardware ‐ Available only for Matrx Elite Backs 4 HCPCS Code: E1028

QUANTITY MODEL DESCRIPTION MSRPq QTY____ SAHEB Swing‐Away Lateral Hardware Only (each) $225.00

Offset, Swing‐Away Hardware* Available only for Matrx Elite Backs 4 HCPCS Code: E1028

Allows 3" variance (higher or lower) pad position relative to attachment slot.

QUANTITY MODEL DESCRIPTION MSRPq QTY____ OSAH‐L Offset, Swing‐Away Lateral Hardware Only (each) $225.00q QTY____ OSAH‐R Left or Right available

Pads for Offset, Swing‐Away and Swing‐Away Hardware 4 HCPCS Code: E0956

QUANTITY MODEL DESCRIPTION MSRPq QTY____ EPAD‐XS Extra Small Pad: 3.25" High x 4.25" Long (each) $110.00q QTY____ EPAD‐S Small Pad: 3.5" High x 5.25" Long (each) $110.00q QTY____ EPAD‐M Medium Pad: 3.75" High x 5.75" Long (each) $110.00q QTY____ EPAD‐L Large Pad: 4.25" High x 6.5" Long (each) $110.00

L R

MATRX®MINI LATERALS: Available for Matrx Mini Backs

Swing‐Away Hardware* ‐ Available only for Matrx Mini Backs 4 HCPCS Code: Pending

QUANTITY MODEL DESCRIPTION MSRPq QTY____ SAHMINI Swing‐Away Lateral Hardware Only (each) $225.00

& Elite DeepBacks

& Elite Deep Backs



1.888.433.6818 FAX: 1.888.433.6834 1 of 22 TRD0366 REV E

Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORM

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HARDWARE UPGRADES: Available for Standard Matrx PB and Elite Backs

Hardware OptionsNo‐charge substitutions for Easy Set hardware are available & must be specified at time of ordering back

NO-CHARGE SUBSTITUTION MODEL # HARDWARE ONLY MODEL # MSRP

Easy Set Hardware (pair) ‐ Fits 3/4", 7/8", 1" back canes (Standard on PB & Elite Backs)

q PBMH . . . . . . . . . . . . . . . . . . . .$225.00

Easy Set Hardware (pair) ‐ Fits 11/8" back canes q PBMH‐QU . . . . . . . . . . . . . . . . . . . . . .N/C q PBMH‐Q . . . . . . . . . . . . . . . . . .$225.00

Easy Set Hardware (pair) ‐ Fits 1¼" back canes q PBMX‐XU . . . . . . . . . . . . . . . . . . . . . .N/C q PBMX‐X . . . . . . . . . . . . . . . . . .$225.00

Heavy‐Duty Easy Set Hardware (pair) ‐ Fits 3/4", 7/8", 1" back canes (Upcharge on Standard PB & Elite Backs)q HDU . . . . . . . . . . . . . . . . . . . . . . .$125.00

Extended Range Mounting Hardware (pair) ‐ Provides additional 2" Depth adjustment (Available for Standard PB & Elite Backs) NOT compatible with SMH/SMH‐Uq ERMHU . . . . . . . . . . . . . . . . . . . . . . . .N/C q ERMH . . . . . . . . . . . . . . . . . . . .$225.00

Split Mounting Hardware (pair) ‐ (Available for Standard PB & Elite Backs)For avoidance of obstacles on Frameq SMHU . . . . . . . . . . . . . . . . . . . . . . . . .N/C q SMH . . . . . . . . . . . . . . . . . . . . .$250.00

Fixed Space Saver Mounting Hardware (pair) Permanent mount recommended for Power Wheelchair application or when portability is not requiredFor Matrx PB & Elite Standard or Heavy‐Duty Backs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSHU . . . . . . . . . . . . . . . . . . . . . . . . .N/C q FSSH . . . . . . . . . . . . . . . . . . . . .$200.00

For Formula Tilt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSH‐FTU . . . . . . . . . . . . . . . . . . . . . .N/C q FSSH‐FT . . . . . . . . . . . . . . . . . .$200.00

For Formula Tilt/Recline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSH‐FTRU . . . . . . . . . . . . . . . . . . . . .N/C q FSSH‐FTR . . . . . . . . . . . . . . . . .$200.00


& Elite Deep Backs

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Hardware OptionsNo‐charge substitutions for Easy Set hardware are available & must be specified at time of ordering back

NO-CHARGE SUBSTITUTION MODEL # HARDWARE ONLY MODEL # MSRP

Easy Set Hardware (pair) ‐ Fits 3/4", 7/8", 1" back canes (Standard on PB & Elite Backs)

q PBMH . . . . . . . . . . . . . . . . . . . .$225.00

Easy Set Hardware (pair) ‐ Fits 11/8" back canes q PBMH‐QU . . . . . . . . . . . . . . . . . . . . . .N/C q PBMH‐Q . . . . . . . . . . . . . . . . . .$225.00

Easy Set Hardware (pair) ‐ Fits 1¼" back canes q PBMX‐XU . . . . . . . . . . . . . . . . . . . . . .N/C q PBMX‐X . . . . . . . . . . . . . . . . . .$225.00

Heavy‐Duty Easy Set Hardware (pair) ‐ Fits 3/4", 7/8", 1" back canes (Upcharge on Standard PB & Elite Backs)q HDU . . . . . . . . . . . . . . . . . . . . . . .$125.00

Extended Range Mounting Hardware (pair) ‐ Provides additional 2" Depth adjustment (Available for Standard PB & Elite Backs) NOT compatible with SMH/SMH‐Uq ERMHU . . . . . . . . . . . . . . . . . . . . . . . .N/C q ERMH . . . . . . . . . . . . . . . . . . . .$225.00

Split Mounting Hardware (pair) ‐ (Available for Standard PB & Elite Backs)For avoidance of obstacles on Frameq SMHU . . . . . . . . . . . . . . . . . . . . . . . . .N/C q SMH . . . . . . . . . . . . . . . . . . . . .$250.00

Fixed Space Saver Mounting Hardware (pair) Permanent mount recommended for Power Wheelchair application or when portability is not requiredFor Matrx PB & Elite Standard or Heavy‐Duty Backs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSHU . . . . . . . . . . . . . . . . . . . . . . . . .N/C q FSSH . . . . . . . . . . . . . . . . . . . . .$200.00

For Formula Tilt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSH‐FTU . . . . . . . . . . . . . . . . . . . . . .N/C q FSSH‐FT . . . . . . . . . . . . . . . . . .$200.00

For Formula Tilt/Recline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q FSSH‐FTRU . . . . . . . . . . . . . . . . . . . . .N/C q FSSH‐FTR . . . . . . . . . . . . . . . . .$200.00


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BACK OPTIONS & MODIFICATIONS Available for Pediatric, Matrx Mini Backs

ModificationsQUANTITY MODEL COMPONENT MSRPq QTY____ HIMINI Chest Harness Interface Kit ‐ for Mini Back $85.00

Chest Harness is not included ‐ mounting kit only

HARDWARE UPGRADES: Available for Pediatric, Matrx Mini Backs

Options:HARDWARE ONLY MODEL # MSRP

Mini Set Mounting Hardware (pair)‐ Fits 3/4", 7/8", 1" back canes (Standard on Mini Backs)

q MSMH . . . . . . . . . . . . . . . . . . .$225.00


Hardware Options ContinuesHARDWARE ONLY MODEL # MSRP

ESR Mounting HardwareAllows PB & Elite Backs to be mounted to Motion Concepts TRx Power Positioning with ESR

q ESRMH . . . . . . . . . . . . . . . . . . .$260.00

QUANTITY MODEL DESCRIPTION MSRP

Removable Mounting Kit for Power Tilt/Recline – Power Wheelchair application (Available for Matrx PB & Elite Standard exclusive of Backs less than 14" wide) q QTY____ PERMMH Mounting Kit for Permobil Tilt/Recline $250.00q QTY____ QUANMH Mounting Kit for Quantum Tilt/Recline $250.00q QTY____ QUIKMH Mounting Kit for Quickie Tilt/Recline $250.00



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Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

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BACK OPTIONS & MODIFICATIONS

ModificationsQUANTITY MODEL COMPONENT MSRPq QTY____ MAC Miscellaneous Modification $100.00

Special Request ‐ Approval requiredSPECIFY: ______________________________________________________

________________________________________________________________________________________________________________________

q QTY____ WSC Wipeable Slipcover $150.00 Moisture resistant, wipeable cover with a zipperAvailable for Matrx PB or Elite Back

SPECIFY: q PB q PB Deep q PB Heavy‐Duty q PB Deep Heavy‐Dutyq Elite q Elite Full q Elite Tilt/Recline q Elite Deep q Elite Heavy‐DutySPECIFY: WIDTH_____ HEIGHT_____ q QTY____

q QTY____ WSCU Wipeable Slipcover ‐ ordered with back $100.00 Moisture resistant, wipeable cover with a zipperAvailable for Matrx PB or Elite Back

q QTY____ EBSS Elite Back/Cover ‐ SuperSoft Foam $100.00SuperSoft Foam ‐ 1" soft over 1" firm HR foam

SPECIFY: q Elite q Elite Deep q Elite Heavy‐DutySPECIFY: WIDTH_____ HEIGHT_____ q QTY____

q QTY____ PBVF PB/Elite Back/Cover Modification $100.00Visco Foam over HR Foam


q QTY____ EMP Extended Mounting Pins $60.00Allows Matrx PR or Elite Backs to be mountedon wheelchairs that are 2" wider than the back model width ‐‐only for backs 20" wide and 300 lbs weight capacity. Not compatible with FSSH.

q QTY____ CHIEB Chest Harness Interface Kit ‐ for Elite Back $95.00 Chest Harness is not included ‐ mounting kit only

q QTY____ CHIPB Chest Harness Interface Kit ‐ for PB Back $45.00 Chest Harness is not included ‐ mounting kit only

q QTY____ EHRA‐S Small Headrest Adapter ‐ for Elite Back $35.00 For Attachment of headrests to Elite12" wide backs

q QTY____ EHRA‐M Medium Headrest Adapter ‐ for Elite Back $35.00 For Attachment of headrests to Elite Backs13" ‐ 17" wide backs

q QTY____ EHRA‐L Large Headrest Adapter ‐ for Elite Back $35.00 For Attachment of headrests to Elite Heavy‐Duty 18" ‐ 22" wide backs


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Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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ModificationsQUANTITY MODEL COMPONENT MSRPq QTY____ STARTEX‐F Startex ‐ Fabric Side up $50.00

Available for PB and Elite BacksSPECIFY: q PB q PB Deep q PB Heavy‐Duty q PB Deep Heavy‐Duty

q Elite q Elite Full q Elite Tilt/Recline q Elite Deep q Elite Heavy‐DutySPECIFY: WIDTH_____ HEIGHT_____ q QTY____

q QTY____ STARTEX‐S Startex ‐ Smooth Side up $50.00 Available for PB and Elite Backs


q QTY____ NSF Non‐Standard Fabric Selection $75.00 Available for all backs; excluding Elite & Mini models

SPECIFY: ______________________________________________________________________________________________________________________________________________________________________________

SPECIFY: WIDTH_____ HEIGHT_____ q QTY____qQTY____ FIP Foam‐in‐place Kit for PB Back $200.00

Chemical Kit for custom foam moldq QTY____ PBSC PB Back Stretch Cover Upgrade $50.00

For use with Foam‐in‐place Kit on Matrx PB BackSPECIFY: q PB q PB Deep q PB Heavy‐Duty q PB Deep Heavy‐Duty


MILITARY SERVICE EMBLEMS: Available for all Matrx Backs

3" Decal ‐ Available for all Elite and MX1 BacksMSRP

3" Diameter Decal N/Cq ARMY q NAVY q AIR FORCE q MARINES

6" Embroidery Patch ‐ Available for Matrx PB BacksMSRP

6" Diameter Embroidery Patch N/Cq ARMY q NAVY q AIR FORCE q MARINES


9" Diameter Embroidery Patch $25.00q ARMY q NAVY q AIR FORCE q MARINES


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Date of Order:______________________________________________

Dealer Name: ______________________________________________

Dealer Account #: __________________________________________

PO #: ____________________________________________________

Tag: ______________________________________________________


Phone: ____________________Fax: ____________________________

Ship to Address: ____________________________________________

__________________________________________________________

City: ______________________________________________________

State:____________________Zip: ______________________________

Comments: ________________________________________________

__________________________________________________________

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INVACARE® MATRX® BACKS – FREEDOM DESIGNS ON-CHAIR ORDER FORMINVACARE® MATRX® SEATING SERIES – US PRICE LIST

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MATRX ACCESSORIES

AccessoriesQUANTITY MODEL COMPONENT MSRPq QTY____ PFLAP‐XS X‐Small Privacy Flap $40.00

10" W x 16" H ‐ fits 12"‐14" wide backsq QTY____ PFLAP‐S Small Privacy Flap $40.00

13" W x 16" H ‐ fits 15"‐16" wide backsq QTY____ PFLAP‐M Medium Privacy Flap $40.00

15" W‐ 16" H ‐ fits 17"‐18" wide backsq QTY____ PFLAP‐L Large Privacy Flap $40.00

17"W ‐ 16" H ‐ fits 19"‐20" wide backsq QTY____ PFLAP‐XL X‐Large Privacy Flap $40.00

19" W‐ 16" H ‐ fits 21"‐22" wide backsqQTY____ PFLAP‐XXL XX‐Large Privacy Flap $40.00

21" W‐ 16" H ‐ fits 23"‐24" wide backsq QTY____ PBCR Posture Back Cane Replacement (pair) $115.00

1" Diameter back cane replacement kit

q QTY____ PBCI3 Posture Back Cane Clamp Inserts (pair) N/CInsert for use with ¾” back banes

Documents

TRX BA EED DE - DE INVACARE MATRX ... - Freedom Designs, Inc.freedomdesigns.com/Literature/SP Literature/Matrx... · FREEDOM DESIGNS ON-CHAIR ORDER FORM ... Invacare® Matrx® MX1