Please select if this is intended to be a quote or a sales order. Quotes will be emailed within 24 business hours. Sales orders will be invoiced within 24 business hours.
This should be a contact number for someone at the delivery address. Our freight forwarder will contact this number to schedule delivery.
This email address should be a contact at the place of delivery. Our freight forwarder will email to set up a time for delivery. We will not use this email for invoicing.
25106 (Small over knees) is typically for Seat Widths of 10", 11", 12" and 13" 25107 (Large over knees) is typically for Seat Widths of 13", 14" and 15" 25108 (X-Large over knees) is typically for Seat Widths of 16", 17" and 18"
Choose a second color option for the side guard, footrest, and fork color for an additional $200.
Upgrade the paint job and add an accent color! The accent color will add an extra flare to the foot tubing, sideguards, and forks.
Choose a second accent color option for the foot plate, foot clamps, and seat links for an additional $200.
Want your chair to have the most personality? Upgrade the paint job and add a third color! The Third color will add an extra flare to the foot clamps, Foot-Plate, and Seat Links.
Please leave any special requests in this box. Note: All special requests are subject to approval, additional charges, and additional lead time.
DISCLAIMER: Please contact customer service directly to make changes to an order form. Once the order form has been submitted change of selections cannot be applied. Any changes made after the order has begun production will need to go through approval from management before changes are accepted.
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