(E2622) $680
(E2622) $800
(E2622) $705
(E2624) $680
(E2624) $800
(E2624) $705
16" x 16" Qty: ______
16" x 18" Qty: ______
18" x 16" Qty: ______
(E2623) $880
(E2623) $1,060
(E2623) $925
(E2625) $880
(E2625) $1,060
(E2625) $925
22" x 22" Qty: ______
24" x 20" Qty: ______
(E2623) $1,185
(E2623) $1,415
(E2623) $1,245
(E2625) $1,185
(E2625) $1,415
(E2625) $1,245
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"
REPLACEMENT COMPONENTS
CG Air Dual Valve (Includes Two (2) 3D Mesh Covers)
26" x 20" Qty: ______
CGA2V2ICxxxx-x CG Air Dual Valve (Includes Two (2) Incontinence Covers)
SELECT CELL HEIGHT
26" x 22" Qty: ______
CGA2V2SCxxxx-x CG Air Dual Valve (Includes Two (2) Standard 2-way Stretch Covers)
CGA2V23Dxxxx-x
CGA1V2ICxxxx-x CG Air Single Valve (Includes Two (2) Incontinence Covers)
DUAL (2) VALVE
14" to 20" WIDE
20" x 18" Qty: ______
20" x 20" Qty: ______
Other, specify __________ Qty: ______
18" x 20" Qty: ______
18" x 18" Qty: ______
CG Air THERAPEUTIC SEAT CUSHION
Zip Code:
City:
State:
User Name or Number:
VA (Billing):P.O. # or Quote:
Shipping Name:
ORDERING INFORMATION: PHONE: (888) 453-0311, FAX: (877) 501-8458, EMAIL: info@amylior.com
ACCOUNT INFORMATION
(VA) - October 2020
Email Address:
Fax Number:
Phone Number:
Ship Address:
Contact Name:
CG Air Single Valve (Includes Two (2) 3D Mesh Covers)
CGA1V2SCxxxx-x
CGA1V23Dxxxx-x
CGA1V2ICxxxx-x
CG Air Single Valve (Includes Two (2) Standard 2-way Stretch Covers)
20" x 16" Qty: ______
CGA2V2ICxxxx-x CG Air Dual Valve (Includes Two (2) Incontinence Covers)
SINGLE (1) VALVE
CGA1V2SCxxxx-x
14" x 14" Qty: ______
26" + WIDE
CGA1V23Dxxxx-x
14" x 16" Qty: ______
16" x 14" Qty: ______
CGA2V2ICxxxx-x
SINGLE (1) VALVE
DUAL (2) VALVE
CGA2V2SCxxxx-x CG Air Dual Valve (Includes Two (2) Standard 2-way Stretch Covers)
CGA2V23Dxxxx-x CG Air Dual Valve (Includes Two (2) 3D Mesh Covers)
CG Air Single Valve (Includes Two (2) 3D Mesh Covers)
CG Air Single Valve (Includes Two (2) Incontinence Covers)
22" to 24" WIDE
SINGLE (1) VALVE
CGA1V2SCxxxx-x CG Air Single Valve (Includes Two (2) Standard 2-way Stretch Covers)
SELECT CELL HEIGHT
2"
(Only available in Single Valve)
3"
4"
CG Air Single Valve (Includes Two (2) 3D Mesh Covers)
CGA1V2ICxxxx-x CG Air Single Valve (Includes Two (2) Incontinence Covers)
DUAL (2) VALVE
CGA2V2SCxxxx-x CG Air Dual Valve (Includes Two (2) Standard 2-way Stretch Covers)
CGA2V23Dxxxx-x CG Air Dual Valve (Includes Two (2) 3D Mesh Covers)
CG Air Dual Valve (Includes Two (2) Incontinence Covers)
SELECT CELL HEIGHT
CG Air Single Valve (Includes Two (2) Standard 2-way Stretch Covers)
CGA1V23Dxxxx-x
22" x 18" Qty: ______ 24" x 22" Qty: ______
2"
(Only available in Single Valve)
3"
4"
Other, specify __________ Qty: ______
22" x 20" Qty: ______ 24" x 24" Qty: ______
26" x 24" Qty: ______ 30" x 24" Qty: ______
30" x 20" Qty: ______ Other, specify __________ Qty: ______
30" x 22" Qty: ______
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_____"
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)
MKT.F66
Specifications are subject to change without notice. Copyright @ 2020, Amylior Inc. (October 2020) Amylior CG Air - VA (Rev.3)
Page 1 of 3
CLEAR FORM
SEND BY EMAIL
DELUXE
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)
24681012141618202224262830
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
ORDERING INFORMATION: PHONE: (888) 453-0311, FAX: (877) 501-8458, EMAIL: info@amysystems.com
ACCOUNT INFORMATION
Fax Number:
User Name or Number:
VA (Billing):
Phone Number:
P.O. # or Quote:
Contact Name:
Zip Code:
CGADLX26+-23D
CGADLX26+-2IC
Email Address:
CG Air DELUXE - CUSTOM THERAPEUTIC SEAT CUSHION
14" to 20" WIDE
(Build as per specifications below)
Shipping Name:
Ship Address:
City:
State:
$680
CG Air Deluxe (Includes Two (2) 3D Mesh Covers) -
Below 22" Wide
(E2624) $800
CG Air Deluxe (Includes Two (2) Standard 2-way Stretch Covers) -
Below 22" Wide
(E2624)
CGADLX10-20-2SC
CGADLX10-20-23D
THE COLORS ARE USED TO SHOW THE DIFFERENT
CELL HEIGHT POSSIBILITIES
(E2624)
WIDTH - FRONT OF CUSHION
CG Air DELUXE - CUSTOM ORDER MATRIX
$705
22" to 24" WIDE
(Build as per specifications below)
CG Air Deluxe (Includes Two (2) Standard 2-way Stretch Covers) -
22" to 24" Wide
(E2625) $880
CGADLX10-20-2IC
CGADLX22-24-2SC
CG Air Deluxe (Includes Two (2) Incontinence Covers) -
Below 22" Wide
(E2625) $1,060
CG Air Deluxe (Includes Two (2) Incontinence Covers) -
22" to 24" Wide
(E2625) $925
CGADLX22-24-23D
CGADLX22-24-2IC
26" + WIDE
(Build as per specifications below)
CG Air Deluxe (Includes Two (2) Standard 2-way Stretch Covers) -
26" Wide or more
(E2625) $1,185
CG Air Deluxe (Includes Two (2) 3D Mesh Covers) -
22" to 24" Wide
CG Air Deluxe (Includes Two (2) 3D Mesh Covers) -
26" Wide or more
CG Air Deluxe (Includes Two (2) Incontinence Covers) -
26" Wide or more
DEPTH
CGADLX26+-2SC
$1,245
REPLACEMENT COMPONENTS
CGASCxxxx-x Standard 2-way Stretch Cover. Specify Dimensions: W _____" D _____" H_____" (E2619)
CGA3Dxxxx-x 3D Mesh Cover. Specify Dimensions: W _____" D _____" H_____" (E2619)
$130
$150
CGAICxxxx-x Incontinence Cover. Specify Dimensions: W _____" D _____" H_____" (E2619) $130
$31
$149
STEPS TO FOLLOW TO FILL OUT THE
MATRIX
1. Specify the requested size of the cushion
W ________" x D ________"
2. Specify the cell height ________". If
different heights are needed, indicate 2, 3 or
4 in each square to show each cell height.
3. Specifiy the number of valves as well as
the valve position by writing a "V". If more
than one valve is required, draw a line to
show the compartment area.
4. If cells are not required, indicate an "X" in
the square.
(VA) - October 2020
(E2625) $1,415
(E2625)
MKT.F66
Specifications are subject to change without notice. Copyright @ 2020, Amylior Inc. (October 2020) Amylior CG Air - VA (Rev.3)
Page 2 of 3
25" 12 24" 25" 14 24.5"
24" 12 24" 24" 13 22.75"
23" 11 22" 23" 13 22.75"
22" 11 22" 22" 12 21"
21" 10 20" 21" 12 21"
20" 10 20" 20" 11 19.25"
10 17.5"
19" 9 18" 19" 10 17.5"
17" 8 16" 17" 9 15.75"
16" 8 16" 16" 9 15.75"
15" 7 14" 15" 8 14"
14" 7 14" 14" 8 14"
10.50"
13" 6 12" 13" 7 12.25"
12"
SURFACE OF
CELLS
58.75"
11" 5 10" 11" 6 10.50"
WIDTH OR
DEPTH
# OF CELLS
SURFACE OF
CELLS
WIDTH OR
DEPTH
# OF CELLS
6 12" 12" 6
OTHER MANUFACTURERS
18" 9 18" 18"
10" 5 10" 10"
MEETS FLAMABILITY STANDARDS CAL TB 117-2013
www.amylior.com / info@amylior.com / Phone: 888 453-0311 / Fax: 877 501-8458
(VA) - October 2020
SIZING CHART
CG Air
MKT.F66
Specifications are subject to change without notice. Copyright @ 2020, Amylior Inc. (October 2020) Amylior CG Air - VA (Rev.3)
Page 3 of 3