(E2622) $510
(E2622) $564
(E2622) $535
CGA2VSCxxxx-x
NEW
(E2624) $510
CGA2V3Dxxxx-x
NEW
(E2624) $564
CGA2VICxxxx-x
NEW
(E2624) $535
16" x 16" Qty: ______
16" x 18" Qty: ______
18" x 16" Qty: ______
(E2623) $510
(E2623) $564
(E2623) $535
CGA2VSCxxxx-x
NEW
(E2625) $510
CGA2V3Dxxxx-x
NEW
(E2625) $564
CGA2VICxxxx-x
NEW
(E2625) $535
22" x 22" Qty: ______
24" x 20" Qty: ______
(E2623) $610
(E2623) $680
(E2623) $625
CGA2VSCxxxx-x
NEW
(E2625) $610
CGA2V3Dxxxx-x
NEW
(E2625) $680
CGA2VICxxxx-x
NEW
(E2625) $625
28" x 20" Qty: ______
28" x 22" Qty: ______
28" x 24" Qty: ______
(E2619) $130
(E2619) $150
(E2619) $130
$31
$149
□ 2" (Only available in Single Valve) □ 3" □ 4"
□
CGAPK3 CG Air Patch Kit - 3 Patches (Includes alcohol prep pads and adhesive)
□
CGAPK15 CG Air Patch Kit - 15 Patches (Includes alcohol prep pads and adhesive)
CGASCxxxx-x
CGA3Dxxxx-x
CGAICxxxx-x
Standard 2-way Stretch Cover. Specify Dimensions: W _____" D _____" H_____"
3D Mesh Cover. Specify Dimensions: W _____" D _____" H_____"
Incontinence Cover. Specify Dimensions: W _____" D _____" H_____"
□
□
□
26" x 24" Qty: ______ 30" x 24" Qty: ______
30" x 20" Qty: ______ Other, specify __________ Qty: ______
26" x 22" Qty: ______ 30" x 22" Qty: ______
DUAL (2) VALVEDUAL (2) VALVE
CG Air Single Valve (Includes a Incontinence Covers)
Other, specify __________ Qty: ______
22" x 20" Qty: ______ 24" x 24" Qty: ______
SINGLE (1) VALVE
CG Air Single Valve (Includes a Incontinence Covers)
CGA1V3Dxxxx-x
SELECT CELL HEIGHT
CG Air Single Valve (Includes a Standard 2-way Stretch Covers)
□
CGA1V3Dxxxx-x
22" x 18" Qty: ______ 24" x 22" Qty: ______
CG Air Single Valve (Includes a Standard 2-way Stretch Covers)
□
CG Air Dual Valve (Includes a Incontinence Covers)
16" x 14" Qty: ______ Other, specify __________ Qty: ______
CG Air Single Valve (Includes a 3D Mesh Covers)
□
CGA1VICxxxx-x
14" x 14" Qty: ______
26" + WIDE
□
22" to 24" WIDE
SINGLE (1) VALVE
20" x 20" Qty: ______
□
20" x 16" Qty: ______
□ 2" (Only available in Single Valve) □ 3" □ 4"
CGA1VSCxxxx-x
P.O. # or Quote:
Shipping Name:
Billing Name:
Email Address:
ORDERING INFORMATION: PHONE: (888) 453-0311, FAX: (877) 501-8458, EMAIL: info@amylior.com
ACCOUNT INFORMATION
OCTOBER 2020
Ship Address:
Contact Name:
20" x 18" Qty: ______
CG Air Dual Valve (Includes a Incontinence Covers)
DUAL (2) VALVE
Fax Number:
Phone Number:
Zip Code:
City:
State:
CG Air THERAPEUTIC SEAT CUSHION
□
CG Air Dual Valve (Includes a 3D Mesh Covers)
□
User Name or Number:
□
18" x 20" Qty: ______
18" x 18" Qty: ______
□
□
□
14" x 16" Qty: ______
SELECT CELL HEIGHT
□ 2" (Only available in Single Valve) □ 3" □ 4"
CG Air Single Valve (Includes a 3D Mesh Covers)
14" to 20" WIDE
CGA1VSCxxxx-x
CGA1V3Dxxxx-x
CGA1VICxxxx-x
CG Air Single Valve (Includes a Standard 2-way Stretch Covers)
SINGLE (1) VALVE
CG Air Single Valve (Includes a Incontinence Covers)
CG Air Dual Valve (Includes a Standard 2-way Stretch Covers)
□
CG Air Dual Valve (Includes a 3D Mesh Covers)
REPLACEMENT COMPONENTS
26" x 20" Qty: ______
SELECT CELL HEIGHT
CGA1VSCxxxx-x
CGA1VICxxxx-x
CG Air Single Valve (Includes a 3D Mesh Covers)
□
CG Air Dual Valve (Includes a 3D Mesh Covers)
CG Air Dual Valve (Includes a Standard 2-way Stretch Covers)
□
CG Air Dual Valve (Includes a Incontinence Covers)
□
CG Air Dual Valve (Includes a Standard 2-way Stretch Covers)
□
DUAL (2) VALVE
□
MKT.F35
Specifications are subject to change without notice. Copyright @ 2020, Amylior Inc. (October 2020) Amylior CG Air (Rev.3)
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