Fillable M300 Corpus HD Dealer Information * Indicates a (Accident Compensation Corporation New Zealand)

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M300 Corpus HD Dealer Information * Indicates a (Accident Compensation Corporation New Zealand)

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PO#:
_____________________________
_
* Shipping Location:_____________________________
_
Address:
_____________________________
_
* Phone#:_____________________________
_
* Contact:_____________________________
_
* City:_____________________________
_
* Fax#:_____________________________
_
* Weight:______________________________
_
*Height:______________________________
_
A) Top of Shoulders:
______________________________
B) Chest Depth:
______________________________
C) Chest Width:
______________________________
D) Seat Depth:
______________________________
E) Top of Head:
______________________________
F) Elbow to Hand:
______________________________
G) Seat Pan to Elbow:
______________________________
H) Hip Width:
______________________________
*I) Knee to Foot:______________________________
_
Permobil New Zealand Ltd
181A McLeod Rd, Te Atatu South
Auckland 0610, New Zealand
0800 115 222
permobil.com/en-nz
* State
:
_____________________________
_
Diagnosis:
_____________________________
_
Permobil recommends that the client is evaluated by a
certified rehab specialist.
Dealer Information
Client Information
Client Measurements
Funding Source:
_____________________________
_
Prices effective: September 1, 2020
Client Age:
_____________________________
_
Company Code:______________________________
* First Name:_____________________________
_
* Indicates a Required Field
* Last Name:_____________________________
_
Email Address:
_____________________________
_
M300 Corpus HD
PERMNZ
M300 Corpus HD
Chair Model and Colors
CHOOSE BASE:
DescriptionPart Numbe
r
I105799-99-0
M300 Base Corpus HD - MPO
Price Includes: M300 HD Power Base, Shock Absorbing Suspension System, R-net Controller,
Tie-Down Hardware For Strap Systems, Charger, Flat Free Tires, and Standard Positioning Belt.
Must Choose Flat Free or Pneumatic Tires Below. Max Speed = 8kmh, Weight Capacity = 204kg.
CHOOSE WHEEL PACKAGE:
DescriptionPart Numbe
r
Grey Wheel Package - MWD I11081
No Charge
Includes grey tires on 8" silver casters and drive wheel rims. Hub cap color is selected below.
Please select drive wheel type:
Flat free drive tires: _____ Pneumatic drive tires: _____
Black Wheel Package - MWD I11082
No Charge
Includes black tires on 8" silver casters and drive wheel rims. Hub cap color is selected below.
Please select drive wheel type:
Flat free drive tires: _____ Pneumatic drive tires: _____
Blackout Wheel Package - MWDI11083
Custom Option. Includes black tires and custom matte black 8" casters, drive wheels and hub
caps. Please select drive wheel type:
Flat free drive tires: _____ Pneumatic drive tires: _____
OPTIONAL DRIVE TIRES:
DescriptionPart Numbe
r
Tri-Spoke Split Rim w/ Snow Tire Pneumatic 3x8"I10782
Snow tires are designed for use in cold weather conditions. The nylon compound in these tires
remains flexible at low temperatures, but wears more easily. Therefore, the snow tires (sold as
wheel assemblies) are not recommended for year-long use and must be ordered along with
standard drive wheels. Not available with black tires or black rims.
CHOOSE SHROUD COLOR
:
DescriptionPart Numbe
r
M300 HD Shroud - Onyx BlackI105885-99-0
No Charge
M300 HD Shroud - Platinum SilverI105881-99-0
No Charge
M300 HD Shroud - Sublime GreenI105887-99-0
No Charge
M300 HD Shroud - Cobalt BlueI106169-99-0
No Charge
M300 HD Shroud - Phantom GreyI106171-99-0
No Charge
M300 HD Shroud - Pop Star PinkI106159-99-0
No Charge
M300 HD Shroud - Purple RainI106170-99-0
No Charge
M300 HD Shroud - Volcano RedI106160-99-0
No Charge
CHOOSE HUBCAP COLOR:
DescriptionPart Numbe
r
Match Hubcap Color to Shroud: _____
Note: Hub caps will be matched to shroud color if no selection is made.
Solid Color Hub Cap - PairI10871
No Charge
Platinum Silver: _____ Onyx Black: _____ Cobalt Blue: _____ Phantom Gray: _____
Pop Star Pink: _____ Volcano Red: _____ Purple Rain: _____ Titan Blue: _____
Sublime Green: _____ Crystal Blue: _____ Vintage Wine: _____ Extreme Yellow: _____
Chili Pepper Red: _____
Base Options
MUST CHOOSE EITHER SEAT ELEVATOR OR FIXED SEAT TUBE:
DescriptionPart Numbe
r
HD Power Adjustable Seat Height - 8" TravelI105875-99-0
Please Note: Drive is restricted when seat is in an elevated position.
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Rev 2020-1 08/17/2020
M300 Corpus HD
Base Options
MUST CHOOSE EITHER SEAT ELEVATOR OR FIXED SEAT TUBE:
DescriptionPart Numbe
r
HD Seat Tube Fixed I105880-99-0
No Charge
MUST CHOOSE BATTERIES:
DescriptionPart Numbe
r
I108999-99-0
BATTERY OPTIONS:
Permobil Batteries, MK Battery G24 Pair. Comes with Power First Charger
For maximum range. Includes Permobil VoltPro charger optimized for Permobil Batteries.
CHOOSE SEAT PAN TO FLOOR HEIGHT:
DescriptionPart Numbe
r
Set Seat to Floor Height at 18"I105878-99-0
No Charge
Set Seat to Floor Height at 19"I105877-99-0
No Charge
Set Seat to Floor Height at 20"I105876-99-0
No Charge
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Enhanced Steering Perform Unit (ESP), R-netI105428-99-0
Recommended item with switched drive inputs for improved tracking.
LED Light Kit for M300 / M400 w/ R-net ElectronicsI105297-99-0
Compact Laptop Ventilator Tray - Corpus SeatI10715
A
ccommodates Pulmonetics LTV Series and similar sized Laptop Ventilators. The tray is 13"T,
adjustable in width from 8" - 13", and adjustable in depth from 2" - 6.5". Overall backrest angle
limited to 150° when mounting this ventilator tray. Custom Option. Additional drive restrictions
may apply.
Battery Tray for Laptop Ventilator TrayI10787
Measures 11 3/8" W x 6 1/2" H x 1 5/8" D. Accomodates Pulmonetic Systems Lithium-Ion
Battery Pack, CareFusion SprintPack Battery System, or Richardson PowerTech Vent Power
Center. Custom Option.
O2 Holder for Laptop Ventilator TrayI10788
Mounts to Left or Right Side of Laptop Vent Tray. O2 Holder is 7" Tall. Width infinitely
adjustable from 3.5" - 7". Depth infinitely adjustable from 3.75" - 5". Custom Option.
Programming Key for R-net - Permobil VersionID51113
Joystick Options
PLEASE NOTE:
For additional input devices, refer to Alterative Drive Systems section.
Color Joystick Module, (CJSM)I107779-99-0
This R-net color joystick features: A Large High-Resolution 3.5" VGA color display, control of
up to 4 Bluetooth devices, Infrared control, programmable buttons and a programmable switch
j
ack; all in a compact, durable Aluminum housing.
Permobil Joystick Module I107778-99-0
Designed exclusively for Permobil, this R-net color joystick features: a 2.8" color display,
control of up to 4 Bluetooth devices, Infrared control, programmable buttons and a
p
rogrammable switch jack; all in a compact, durable Aluminum housing.
3.5mm Y-Splitter Cable for PJSM/CJSMI107829-99-0
For use with the PJSM or CJSM Mode/Profile jack. Allows 2 mechanical switches to control 4
separate functions. Requires PC Programming to assign the short hold and long hold
commands to each switch. Switches sold separately.
R-net LED Remote Joystick - No DisplayI105246-99-0
No Charge
This Joystick does NOT have a Display Screen, does NOT contain mono jack ports, and does
NOT include Bluetooth or Assignable Buttons. PC Programming required and profiles limited t
o
five.
Pa
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Rev 2020-1 08/17/2020
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxx
I107031-99-0
M300 Corpus HD
Joystick Options
R-net Remote Color JS w/ Lights, Heavy Duty GimbalI105700-99-0
Heavy-Duty modification enables gimbal to hold up to extreme operating forces. Reinforced
housing is attached to a standard Color LCD R-net Joystick. 3" long joystick knob has 3/4"
diameter. Not compatible with alternative joystick handles.
CHOOSE JOYSTICK HANDLE TYPE:
DescriptionPart Numbe
r
Cone Shaped Joystick Knob - StandardI10045
No Charge
Chin Cup For Joystick KnobI100960-99-0
"T" Handle For Joystick KnobI100961-99-0
"Large Ball" For Joystick KnobI100962-99-0
"Softball" For Joystick KnobI100963-99-0
"Mushroom" For Joystick KnobI100964-99-0
"Stick" For Joystick KnobI100965-99-0
1.75" Black Foam Ball For Joystick KnobI105442-99-0
Bodypoint J/S Handle 3" U-Shaped w/ Flex-ShaftI105846-99-0
Bodypoint J/S Handle 4" U-Shaped w/ Flex-ShaftI105847-99-0
Bodypoint J/S Handle Dome Shaped, RubberI105848-99-0
CHOOSE JOYSTICK MOUNT:
DescriptionPart Numbe
r
Joystick Mount Right - FixedI10664
No Charge
Joystick Mount Left - FixedI10665
No Charge
Joystick Mount Right - Swing AwayI102537-99-0
Joystick Mount Left - Swing AwayI102538-99-0
Slimline Retractable Joystick Mount - RightI108037-99-0
Slimline Retractable Joystick Mount - LeftI108038-99-0
Adjustable Height Panel BracketI11232
Provides 1.77" of vertical adjustment below the armrest and 25° of angle adjustment.
Compatible with all Permobil joystick mounts except for the M1 Fixed Joystick Mount.
Mount Standard Joystick on Corpus Back HingeI105210-99-0
Standard R-net Joystick is mounted to backrest hinge. Can be chosen instead of PN
I105408-99-0. Mount on Left: _____ Mount on Right: _____
Co-Pilot Attendant Control R-net - CorpusI105225-99-0
Attendant Control R-net I105408-99-0
R-net Bluetooth iDevice ModuleI107350-99-0
A
llows input device commands (such as joystick nudges or switch clicks) to be used to operate
an iPhone, iPad or iPod. By assigning each input to an iOS function, users can make phone
calls, send texts and emails and access applications. Kit includes a Bluetooth iDevice Module,
an R-net Bus Cable, and two mono jack cables for direct switch inputs (switches not included).
Must be ordered with a Color JSM or Omni for mode display.
R-net Bluetooth Mouse ModuleI107367-99-0
Enables mouse control through any R-net input device. It can operate the mouse on a
computer and on select Android devices (with R-net for Android app). Kit includes a Bluetooth
Mouse Module, an R-net Bus Cable, two mono jack cables for L/R click (switches not included)
and a USB BT Adapter for user's computer. Note: BT Adapter may not work with all
computers. Must be ordered with a Color JSM or Omni for mode display.
Add a second Bluetooth Mouse ModuleI107368-99-0
A
llows R-net to simultaneously pair to a second compatible computer or Android device. Each
module is accessible through a separate R-net mode. Kit includes a unique Bluetooth Mouse
Module, an R-net Bus Cable, two mono jack cables for L/R click and a USB BT Adapter.
Output Module (IOM) for R-net Control SystemI10582
This allows a user to control an external device (ex: Communication Device, ECU, Door
Opener, etc.) through the drive input (JSM, Head Array, etc.). Each module can provide up to
4
switch closures. May require specialty cable or wiring. Up to three output modules can be
installed on one wheelchair.
Page 4 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Seating System
CHOOSE SEATING SYSTEM:
DescriptionPart Numbe
r
I10910
I10911
I10912
PLEASE NOTE:
Weight Limit 204kg. For the Corpus HD Seat on the M300, there is a half speed drive limit
when the Total Backrest Angle (TBA) > 135° and a drive inhibit at 150° of TBA. There is also a
drive inhibit at 20° of tilt.
HD Seat w/ No Tilt & Manual Recline
HD Seat w/ No Tilt & 150° Power Recline
HD Seat w/ 45° DuraCore Tilt & Manual Recline
HD Seat w/ 45° DuraCore Tilt & 150° Power Recline
I10913
Seating System Options
Seat Function Control Kit for R-netI10585
Please indicate below if you would like push buttons or toggles on the ICS Switchbox.
CHOOSE PUSH BUTTONS OR TOGGLES:
DescriptionPart Numbe
r
Push Buttons on ICS SwitchboxI102798-99-0
No Charge
Toggle Switches on ICS SwitcboxI102799-99-0
Do Not Install ICS Switchbox, Send as PartI105409-99-0
No Charge
CHOOSE MOUNTING POSITION OF ICS SWITCHBOX:
DescriptionPart Numbe
r
Mount ICS Switchbox onto R-net Joystick BracketI10626
No Charge
ICS Switchbox will be mounted to the same bracket as the R-net Joystick Module. If this item
is selected, the ICS Switchbox will swing away with the Joystick Module.
Mount ICS Switchbox onto ArmrestI104651-99-0
No Charge
Mount on Left: _____ Mount on Right: _____
Mount ICS Switchbox on BackrestI106256-99-0
Mount on Left: _____ Mount on Right: _____
OPTIONAL ITEMS:
DescriptionPart Numbe
r
ICS Alternative Switchbox for R-net ElectronicsI104196-99-0
Seat function interface box that accommodates up to 8 momentary switches. Provides an
additional method for accessing the seat functions. 1/8" mini-mono switches not included.
Remote Stop System - AUS/NZ/EUI108526-99-0
Consists of a 433MHz Radio Frequency (RF) handheld transmitter and an RF receiver
mounted on the wheelchair.
Memory Seat Program, Corpus w/ R-netI10750
Legrest Movement Linked to Recline ElectronicallyI106209-99-0
Power Legrest will raise when Power Recline moves backward and will lower when back
moves forward. If Power Legrest is operated, Power Recline will NOT automatically reposition.
Feature works through ICS Switchbox and Driver Control.
Enable Independent Repositioning ModeI10898
No Charge
IRM allows for sequential movement of power seat functions into a posterior position (35° tilt,
115° recline, 135° legrest) and returns to upright position (5° tilt, 100° recline, 110° legrest).
This can be accessed using a standard drive control or a single switch. On the Permobil
Joystick Module, IRM is accessible through the mode/profile jack (long switch hold). Please
see the Alt Drive Accessories section for switch options.
Virtual Seating Coach PackageI107706-99-0
No Charge
The Virtual Seating Coach (VSC) Package includes a Bluetooth dongle which enables access
to VSC coaching and regimen management. The VSC app can be downloaded for free from
the App Store or Google Play. Requires an iPhone (iOS 9 or higher) or an Android phone (OS
4. 1. 2 or higher). USB Charger and RAM X Grip Phone or Tablet Holder recommended.
Page 5 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Backrest Options
CHOOSE FIXED OR SLIDING BACKREST KIT:
DescriptionPart Numbe
r
Sliding Backrest Kit - 5" Mechanical ShearI105871-99-0
No Charge
Fixed Backrest Kit - No Mechanical ShearI105869-99-0
CHOOSE BACKREST TYPE:
DescriptionPart Numbe
r
BACKREST HEIGHT NOTE:
Backrest heights are measured from the seat pan to the top of the backrest shell with the
backrest set at 90°.
Corpus 3G Ergo Backrest - 20"W x 21"T (C3GERGBCA)I106016-99-0
Corpus 3G Ergo Backrest
- 22"W x 21"TI106017-99-0
Corpus 3G Ergo Backrest
- 24"W x 21"TI106018-99-0
PLEASE NOTE:
Taller backrests listed below include: foam lumbar pads*, a UT rail mounted at the top for
lateral adjustment of the headrest, and split backrest feature with height adjustment in 1"
increments. Please indicate below where you want the height set at so that a properly sized
backrest cushion can be provided. * Foam lumbar pads not included with Solid Backs.
Corpus 3G Ergo Back -20"W x 24 - 29"T (C3GERGBCA)I106019-99-0
Corpus 3G Ergo Back -22"W
x 24 - 29"TI106020-99-0
Corpus 3G Ergo Back -24"W
x 24 - 29"TI106021-99-0
Set Backrest at 24"
_____
Set Backrest at 25" _____
Set Backrest at 26" _____
Set Backrest at 27" _____
Set Backrest at 28" _____
Set Backrest at 29" _____
CHOOSE BACKREST CUSHION:
DescriptionPart Numbe
r
Leatherette Cushion - Corpus Ergo BackI10659
No Charge
Black Mesh Cushion - Corpus Ergo BackI10660
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Split Backrest Cushion - CorpusI10725
Custom Option.
Seat Sizing
CHOOSE SEAT WIDTH SETTING:
DescriptionPart Numbe
r
Set Seat Width at 19" I105859-99-0
No Charge
Set Seat Width at 21" I105860-99-0
No Charge
Set Seat Width at 23" I105861-99-0
No Charge
Set Seat Width at 25" I105862-99-0
No Charge
CHOOSE SEAT DEPTH:
DescriptionPart Numbe
r
PLEASE NOTE:
Odd numbered seat depths can be made 1" shorter without any additional parts. For example,
a 21"D Seat can also be set at 20"D.
Corpus HD Seat Depth 19" I105863-99-0
No Charge
Corpus HD Seat Depth 20" I105864-99-0
No Charge
Corpus HD Seat Depth 21" I105865-99-0
No Charge
Page 6 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Seat Sizing
CHOOSE SEAT DEPTH:
DescriptionPart Numbe
r
Corpus HD Seat Depth 22" I105866-99-0
No Charge
Corpus HD Seat Depth 23" I105868-99-0
No Charge
Corpus HD Seat Depth 24" I105856-99-0
No Charge
Corpus HD Seat Depth 25" I105857-99-0
No Charge
CHOOSE SEAT CUSHION:
DescriptionPart Numbe
r
Corpus Ergo Cushion - Leatherette (C3GERGSCA)I10651
Corpus Ergo Cushion - Black FabricI10652
Incontinence Cover for Ergo CushionI11113
Made from a stretch Dartex fabric and suitable for all Ergo cushions including the Corpus Ergo
A
ir. The cover is cut to the contours of the Ergo cushion and is designed to be used as an
outer layer of protection. Cover size will be matched to cushion size. Sent as a part.
Omit Seat Cushion I105118-99-0
No Charge
Armrest Options
CHOOSE ARMBAR MOUNTING POSITION
:
DescriptionPart Numbe
r
Set Armbar at 20"W Between Armrests:____I106022-99-0
No Charge
Set Armbar at 21"W Between Armrests:____I106023-99-0
No Charge
Set Armbar at 22"W Between Armrests:____I106024-99-0
No Charge
Set Armbar at 23"W Between Armrests:____I106025-99-0
No Charge
Set Armbar at 24"W Between Armrests:____I106026-99-0
No Charge
Set Armbar at 25"W Between Armrests:____I106027-99-0
No Charge
CHOOSE ARMREST HEIGHT MOUNTING POSITION
:
DescriptionPart Numbe
r
Height Adjustable Amrests I10923
Height Adjustable Amrests - NCI10924
No Charge
SET ARMREST HEIGHT AT:____
Corpus HD Armrests are infinitely adjustable from 8" - 16", measured from the seat pan to the
top of the arrmrest pad. No additional parts are needed to get this full range of adjustment. In
one inch increments (ex: 8", 9", etc.), please indicate where you would like the armrests set.
CHOOSE ARMREST PAD RIGHT:
DescriptionPart Numbe
r
I105104-99-0
No Charge
I105997-99-0
No Charge
I105999-99-0
No Charge
I106047-99-0
No Charge
I105993-99-0
No Charge
I105995-99-0
No Charge
I107593-99-0
I108246-99-0
I107597-99-0
I108861-99-0
I108863-99-0
4"x13" Corpus Armrest Pad Right - Leatherette
4"x16" Corpus HD Armrest Pad Right - Leatherette
4"x18" Corpus HD Armrest Pad Right - Leatherette
4"x13" Corpus Armrest Pad Right - Black Fabric
4"x16" Corpus HD Armrest Pad Right - Black Fabric
4"x18" Corpus HD Armrest Pad Right - Black Fabric
4"x13" Corpus Arm w/ Permobil Gel Pad - Right
4"x16" Corpus HD Arm w/ Permobil Gel Pad - Right
4"x18" Corpus HD Arm w/ Permobil Gel Pad - Right
Moldable Forearm Support - Right
11.3"L x 5"W. Not compatible with armrest pouch, trays (except Small Tray) or the VS Chest
Support.
Contoured Hand Pad Medium - Right
6.4"L x 5.5" W. For use with Moldable Forearm Supports only. Not compatible with Slimline or
Fixed joystick mounts or Adjustable Height Panel Bracket.
Page 7 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Armrest Options
CHOOSE ARMREST PAD RIGHT:
DescriptionPart Numbe
r
Contoured Hand Pad Large - RightI108865-99-0
7.7"L x 6.1" W. For use with Moldable Forearm Supports only. Not compatible with Slimline or
Fixed joystick mounts or Adjustable Height Panel Bracket.
CHOOSE ARMREST PAD LEFT:
DescriptionPart Numbe
r
I105102-99-0
No Charge
I105996-99-0
No Charge
I105998-99-0
No Charge
I106046-99-0
No Charge
I105992-99-0
No Charge
I105994-99-0
No Charge
I107592-99-0
I108247-99-0
I107596-99-0
I108860-99-0
I108862-99-0
I108864-99-0
4"x13" Corpus Armrest Pad Left - Leatherette
4"x16" Corpus HD Armrest Pad Left - Leatherette
4"x18" Corpus HD Armrest Pad Left - Leatherette
4"x13" Corpus Armrest Pad Left - Black Fabric
4"x16" Corpus HD Armrest Pad Left - Black Fabric
4"x18" Corpus HD Armrest Pad Left - Black Fabric
4"x13" Corpus Arm w/ Permobil Gel Pad - Left
4"x16" Corpus HD Arm w/ Permobil Gel Pad - Left
4"x18" Corpus HD Arm w/ Permobil Gel Pad - Left
Moldable Forearm Support - Left
11.3"L x 5"W. Not compatible with armrest pouch, trays (except Small Tray) or the VS Chest
Support.
Contoured Hand Pad Medium - Left
6.4"L x 5.5" W. For use with Moldable Forearm Supports only. Not compatible with Slimline or
Fixed joystick mounts or Adjustable Height Panel Bracket.
Contoured Hand Pad Large - Left
7.7"L x 6.1" W. For use with Moldable Forearm Supports only. Not compatible with Slimline or
Fixed joystick mounts or Adjustable Height Panel Bracket.
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Corpus Arm Trough Adapter 1" - PairI105463-99-0
For aftermarket armrest pads. Please indicate below if they should be installed or on chair
sent as parts. Please Note: Medial Swivel must be must be locked (I10645 & I10646) when
selecting this option.
Corpus Arm Trough Adpater 7/8" - PairI105462-99-0
For aftermarket armrest pads. Please indicate below if they should be installed or on chair
sent as parts. Please Note: Medial Swivel must be must be locked (I10645 & I10646) when
selecting this option.
Install Arm Trough Adapters: _____
Send Arm Trough Adapters as Parts: _____
Armrest Pouch - Right I107339-99-0
Armrest Pouch - Left I107338-99-0
UT Armrest Side Support - Right OuterI107840-99-0
Includes 2"T x 6.5"W tapered pad.
UT Armrest Side Support - Left OuterI107863-99-0
Includes 2"T x 6.5"W tapered pad.
UT Armrest Side Support - Right InnerI107864-99-0
Includes 2"T x 6.5"W tapered pad. May require an increase to the width between the armrests
to ensure armrests will flip-up.
UT Armrest Side Support - Left InnerI107865-99-0
Includes 2"T x 6.5"W tapered pad. May require an increase to the width between the armrests
to ensure armrests will flip-up.
UT Elbow Support - RightI107839-99-0
Must also select PN I10881.
UT Elbow Support - LeftI107838-99-0
Must also select PN I10882.
Adjustable Elbow Support Hardware - RightI10881
Page 8 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Armrest Options
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Adjustable Elbow Support Hardware - LeftI10882
Legrest Options
CHOOSE LEGREST TYPE:
DescriptionPart Numbe
r
Corpus HD Manual Adj Legrest ElevationI106053-99-0
No Charge
Power Elevating Center Mount Legrests - 175°I106052-99-0
Includes mechanical articulation.
CHOOSE FOOTPLATE STYLE:
DescriptionPart Numbe
r
2pc Wide Corpus Footplates - 9"D x 7.5"WI106008-99-0
No Charge
2pc Extra Wide Corpus Footplates - 10"D x 9"WI106009-99-0
FOOTPLATE HEIGHT POSITION:
DescriptionPart Numbe
r
SET FOOTPLATE HEIGHT AT:____
This is measured from the SEAT PAN to the top of the FOOTPLATE, when the legrest
assembly is at 90° DO NOT INCLUDE CUSHION THICKNESS IN YOUR MEASUREMENT. In
one inch increments, please indicate desired footplate height. NOTE: Standard footplate heigh
t
range is 6" - 18"; however, height may need to be reduced for shipping. Calf Pads are not
available at heights less than 10".
CHOOSE LATERAL FOOTPLATE ROTATION OPTIONS:
DescriptionPart Numbe
r
Lateral Footplate Rotation - FixedI106006-99-0
No Charge
Lateral Footplate Rotation - EnabledI106007-99-0
OPTIONAL ITEMS:
DescriptionPart Numbe
r
VS Calf Support Kit (A) w Mesh Cover & Adj HardwareI106190-99-0
No Charge
5.5"W x 6"T Pad. Compatible with footplate heights of 10" - 18".
VS Calf Support Kit (H) w Mesh Cover & Adj HardwareI106188-99-0
7"W x 7"T Curved Pad. Compatible with footplate heights of 11" - 18".
VS Calf Support Kit (D) w Mesh Cover & Adj HardwareI106186-99-0
8"W x 8"T Pad. Compatible with footplate heights of 12" - 18".
Stealth Gel Pads - Wide Footplates (Pair)I106225-99-0
Stealth Gel Pads - Extra
Wide Footplates (Pair)I106224-99-0
Accessories
MUST CHOOSE POSITIONING BELT:
DescriptionPart Numbe
r
NOTE:
See supplemental order form for more Bodypoint options.
Bodypoint Non-Padded Hip Belt - MediumI104518-99-0
No Charge
CHOOSE ONE OF THE FOLLOWING:
DescriptionPart Numbe
r
Permobil 7"W Headrest w/ Link HardwareI107470-99-0
Must also select I107480-99-0 or I107481-99-0.
Page 9 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Accessories
CHOOSE ONE OF THE FOLLOWING:
DescriptionPart Numbe
r
Permobil 10"W Headrest w/ Link HardwareI107469-99-0
Must also select I107480-99-0 or I107481-99-0.
Permobil 14"W Headrest w/ Link HardwareI107468-99-0
Must also select I107480-99-0 or I107481-99-0.
Adj/Removable Headrest Link Hardware - StandardI107480-99-0
Adj/Removable BodiLink
Headrest Hardware Max8I108721-99-0
Must be selected when ordering any of the Swing Away Chin Boom assemblies.
Swing Away Egg Switch AssemblyI11305
Mount on Upper Left:____ Mount on Upper Right:_____
Swing Away Microlight AssemblyI11306
Mount on Upper Left:____ Mount on Upper Right:_____
Swing Away Facial Pad Assembly 4"L x 2"TI11307
Mount on Upper Left:____ Mount on Upper Right:_____
Swing Away Facial Pad Assembly 6"L x 2"TI11308
Mount on Upper Left:____ Mount on Upper Right:_____
Permobil 10"W Headrest, LeatheretteI106331-99-0
Not available with ROHO AGILITY Back Systems. Must also select PN I10552.
Adj/Removable Headrest HardwareI10552
Universal Headrest
AdapterI107499-99-0
Please Note: Recline is limited to 160° or less (depending on backrest height) when ordering a
Universal Headrest Adapter on a 23" or 24" tall Corpus backrest.
OPTIONAL ITEMS:
DescriptionPart Numbe
r
UT Amp. Support Pad (H) w/ Mesh Cover - (1 Each)I103070-99-0
7"W x 7"T Curved Pad. Must also select PN I10553.
UT Amp. Support Pad (D) w/ Mesh Cover - (1 Each)I103071-99-0
8"W x 8"T Flat Pad. Must also select PN I10553.
Adj Removable - Amp Support Hardware (1 Each)I10553
Please indicate if you would like the amputation support mounted on the right or left side of the
seat frame:
Mount Amp Suppt on Left: _____ Mount Amp Suppt on Right: _____
BodiLink Premium LPTS Pad (B), Stretch-Air - PairI109040-99-0
4.5"W x 3.5"T Pad w/additional foam insert and Stretch-Air cover. Must also select BodiLink
LPTS Mounting Hardware.
BodiLink Premium LPTS Pad (A), Stretch-Air - PairI109043-99-0
6"W x 5.5"T Pad w/additional foam insert and Stretch-Air cover. Must also select BodiLink
LPTS Mounting Hardware.
BodiLink Premium LPTS Pad (C), Stretch-Air - PairI109041-99-0
8"W x 3.5"T Pad w/additional foam insert and Stretch-Air cover. Must also select BodiLink
LPTS Mounting Hardware.
BodiLink Premium LPTS Pad (G), Stretch-Air - PairI109042-99-0
12"W x 3.5"T Pad w/additional foam insert and Stretch-Air cover. Must also select BodiLink
LPTS Mounting Hardware.
Adj/Removable BodiLink LTPS Hdwr Med Corpus PairI109044-99-0
Medium TT Power Mount hardware can be extended upward to clear cushions of 3-5.5" thick.
Adj/Removable Lateral Thigh/Hip Hardware - PairI109194-99-0
Transfer Handles, Corpus
SeatI105260-99-0
Push Handles, Corpus
SeatI105292-99-0
RAM Self-Leveling Cup
HolderI106210-99-0
RAM X-Grip Phone Holder I106806-99-0
Page 10 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Accessories
OPTIONAL ITEMS:
DescriptionPart Numbe
r
RAM X-Grip 10" Tablet Holder w/Swing Away MountI107100-99-0
Compatible with most 10" screen tablets with or without a protective case. Includes adjustable
swing away mount (I103476-99-0). Note: Customization may be required if ordered along with
an Omni.
USB Charger I107222-99-0
Provides up to 1.5A (at 5V) to charge most smartphones and tablets. The charger features an
isolated circuit design for improved safety; and by pulling power from the ICS, prevents battery
drainage when the chair is powered off. Includes mounting hardware and ICS connector. Keep
in mind charger may need to be relocated with some configurations. Mount on left armrest:
_
____ Mount on right armrest: _____
Medical Necessities Bag HooksI105805-99-0
Please Note: Recline is limited to 165° or less (depending on backrest height) when ordering
with 23" or 24" tall Ergo backrest. Custom required if ordered with a ROHO AGILITY backrest.
May ship as a part at shorter backrest heights.
Medical Necessities Bag I102059-99-0
Includes hardware to attach bag to backrest. Please Note: Recline is limited to 165° or less
(depending on backrest height) when ordering with a 23" or 24" tall Ergo backrest. Custom
required if ordered with a ROHO AGILITY backrest.
Adj Removable - Tray Hardware (1 Each)I10556
Permobil Adjustable Tray - 17"WI108227-99-0
Permobil Adjustable Tray - 19"WI108229-99-0
Permobil Tray Hardware Right Side AdjustableI108232-99-0
Permobil Tray Hardware Left Side AdjustableI108233-99-0
Oxygen Holder, Corpus I105224-99-0
Crutch Holder, Corpus I105223-99-0
Stealth Accessories
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Stealth 4" x 6" Lateral Spprts, Original Hdwr, HDI106221-99-0
Must also select I10723. Kit contains the thin, Stealth hardware with swing away brackets and
two height adjustment rails. The rails are bolted to the backrest to provide mounts for the
lateral hardware. PLEASE NOTE: The spacing between the armrests must be at least 1" wider
than the backrest width when ordering these laterals.
Adj Removable Stealth Lateral Hardware (Pair)I10723
Alternative Drive Systems
A
LTERNATIVE PROPORTIONAL JOYSTICK SYSTEMS:
DescriptionPart Numbe
r
Mini-Joystick for Omni - (9-pin connector)I10751
Operating Force = 13 g Neutral to Full Deflection = 5mm
Compact Joystick for Omni - (9-pin connector)I103893-99-0
Operating Force = 220 g Neutral to Full Deflection = 28mm Joystick includes two 3.5mm
mono jacks for Mode and On/Off. Includes Standard Joystick Knob and 1.75" (42mm) Foam
Ball Knob.
Compact Joystick LITE for Omni - (9-pin connector)I103894-99-0
Operating Force = 50 g Neutral to Full Deflection = 17mm Joystick includes two 3.5mm mono
j
acks for Mode and On/Off. Includes Standard Joystick Knob and 1.75" (42mm) Foam Ball
Knob.
Page 11 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Alternative Drive Systems
A
LT PROPORTIONAL JOYSTICK MOUNTING HARDWARE:
DescriptionPart Numbe
r
NOTE:
Please see the PERMOfix Mounting Solutions, within the Alt Drive Accessories section, for
additional mounting options. The Swing Away Chin Boom Assemblies are Compatible with
Permobil Headrests I107470-99-0, I107469-99-0 or I107468-99-0 and must be selected with
I108721-99-0.
Swing Away Chin Boom Assm for Compact Lite - LeftI107946-99-0
Swing Away Chin Boom Assm for Compact Lite - RightI107948-99-0
Swing Away Chin Boom Assm for Mini Joystick - LeftI107857-99-0
Swing Away Chin Boom Assm for Mini Joystick - RightI107947-99-0
Alt. JS Swing Away Mount Kit - ArmrestI104690-99-0
Mount in front of Left Arm: _____ Mount in front of Right Arm: _____
Alt JS/Omni Combo Swing Away Mount Kit - ArmrestI107135-99-0
Used to mount Omni and Alternative Proportional Joystick to the same armrest. Includes
Swing Away Omni/Tablet Mount, with a longer mounting rod, two PERMOfix modules, one 3"
rod and one 4" rod.
Mount in front of Left Arm: _____ Mount in front of Right Arm:_____
Alt. JS Adjustable Mount Kit - Chin BoomI104143-99-0
Swing-Away / Removable Chin Boom mounted on right of backrest shell. Custom charge may
be applied if ordering lower backrest heights.
Haims Harness for Chin Control Mount, LargeI10752
For neck width up to 19cm.
Haims Harness for Chin Control Mount, SmallI10753
For neck width up to 14cm.
A
LT PROPORTIONAL JOYSTICK ACCESSORIES:
DescriptionPart Numbe
r
I104904-99-0
Dual Switches for Compact Joystick - Fixed Mount
Includes two pushbutton switches mounted on rigid arms. Switches set-up for Mode & On/
Off function. Switch operation force = 130 g
Mount at front of Joystick: _____
Mount at rear of Joystick: _____
Mount at left of Joystick: _____ Mount at right of Joystick: _____
Dual Switches for Compact Joystick - Gooseneck MntI104641-99-0
Includes two pushbutton switches mounted on adjustable gooseneck arms. Switches are
p
ositioned on Left and Right sides of Compact Joystick. Switches set-up for Mode & On/Off
function. Switch operation force = 130 g
SIP & PUFF SYSTEMS:
DescriptionPart Numbe
r
Sip & Puff System for OmniI10573
Requires Omni Control Module. Includes breath tube kit.
Sip & Puff System with Fiber Optic Opti-StopI10574
Requires Omni Control Module. Includes breath tube kit.
Sip & Puff Kit for Total Control Head ArrayI106807-99-0
For use with Total Control Head Array. Requires Omni Control Module. Includes breath tube
kit.
Adjustable Mounting Hrdw - Sip & PuffI10762
Required when selecting PN I10573, I10574 or I106807-99-0.
PROPORTIONAL FOOT CONTROL:
DescriptionPart Numbe
r
Proportional Foot Control I10767
Not available with Active Reach Packages.
Mount on Left: _____ Mount on Right: _____
Adjustable Mounting Hrdw - Foot ControlI10766
Required when selecting PN I10767.
Page 12 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Total Control Head Array
CONFIGURE HEAD ARRAY:
DescriptionPart Numbe
r
Permobil Head Array - 3-Switch SystemI106805-99-0
Features an occipital pad sensor and two stainless steel arms configured with proximity
sensors. The arms are mounted to the upper attachment points on the head array. Longer
arms are also included to extend the sensor adjustment range. ESP recommended. Choose
Omni Control Module separately.
Program Head Array as a 5-Switch SystemI11072
No Charge
Select additional arms/sensors below and indicate the intended use of each sensor in the
Notes & Comments section. Choose Omni Control Module separately.
CHOOSE OCCIPITAL PAD SIZE (REQUIRED):
Small Occipital Pad for Head Array - 4.25"W x 3"HI105920-99-0
No Charge
Large Occipital Pad for Head Array - 6"W x 4"HI105921-99-0
No Charge
CHOOSE OCCIPITAL PAD MOUNT (REQUIRED):
Fixed Mount for Occipital Pad - Head ArrayI10847
No Charge
Adj. Swivel Mount for Head Array Occipital PadI105936-99-0
Enables Occipital Pad to be angled up/down and left/right independent of the lateral arms.
CHOOSE HEAD ARRAY MOUNT HARDWARE (REQUIRED):
Stealth TWB480 Backrest Mounting Hdwr with LinksI105927-99-0
Please select the length of the vertical stem below:
Standard length (10"): _____ Short length (6"): _____
Stealth TWB480 Backrest Mtng Hdwr with FlipbackI105941-99-0
Stealth HMO475 Backr Mtng Hdwr w 17mm BallI105925-99-0
SELECT ADDITIONAL LEFT ARM PACKAGE (OPTIONAL):
Add Left Lateral Arm w Proximity SensorI10976
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
Add Left Lateral Arm w Egg SwitchI10977
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
Add Left Lateral Arm w Pad (No Sensor or Switch)I10978
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
SELECT ADDITIONAL RIGHT ARM PACKAGE (OPTIONAL):
Add Right Lateral Arm w Proximity SensorI10979
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
Add Right Lateral Arm w Egg SwitchI10980
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
Add Right Lateral Arm w Pad (No Sensor or Switch)I10981
Choose Lateral Arm Adjustment Range:
Short (5.5" - 10"): ______ Long (5.5" - 14"): ______
Alt Drive Systems Setup
CHOOSE OMNI
(
REQUIRED
)
:
DescriptionPart Numbe
r
Omni2 Control Module for R-net - CorpusI108500-99-0
Two-section design features 3.5" VGA high resolution display, USB charger port, built in IR
control and integrated Bluetooth technology for control of up to 4 Bluetooth devices. Must also
select mounting hardware below. Please specify which type of alternative drive input device
you will be using. Input Device:______________________________
Page 13 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Alt Drive Systems Setup
CHOOSE OMNI
(
REQUIRED
)
:
DescriptionPart Numbe
r
Adjustable Swing-Away Hardware - Omni/TabletI103476-99-0
Mount in front of Left Arm: _____ Mount in front of Right Arm: _____
CHOOSE MOUNTING POSITION OF SEAT CONTROL SWITCHBOX
:
DescriptionPart Numbe
r
Mount Seat Control Switchbox on BackrestI10080
No Charge
Alt Drive Accessories
PERMOFIX MOUNTING SOLUTIONS:
DescriptionPart Numbe
r
PERMOfix UniTrack Fixed Mount KitI106655-99-0
Includes two base joints, two 4" rods and one 8" rod.
PERMOfix UniTrack Removable Mount KitI106656-99-0
Includes quick release mount and thigh support hardware, two base joints and three different
length rods.
PERMOfix UniTrack Swing Away Mount KitI106657-99-0
Includes PERMOfix Swing Away module, two base joints, one 2" rod and one 4" rod.
Proximity Sensor + Swivel Assm - Not MountedI105907-99-0
Only available with the Total Control Head Array. Swivel assembly allows sensor to be
mounted with PERMOfix or directly to lateral arm of Total Control Head Array. Since Proximity
Sensors require power, they CANNOT be used as On/Off switches.
Egg Switch + Swivel Mount Assm - Not MountedI105919-99-0
Swivel assembly allows switch to be mounted with PERMOfix or directly to lateral arm of Total
Control Head Array.
Solid Lateral Pad+Swivel Joint - Not MountedI105912-99-0
Swivel assembly allows pad to be mounted with PERMOfix or directly to lateral arm of Total
Control Head Array.
Oval Plate + Swivel Assm - No Switch - Not MountedI106675-99-0
Blank plate provides mounting option for Micro Lite, Buddy Button or other switch options.
Swivel assembly allows pad to be mounted with PERMOfix or directly to lateral arm of Total
Control Head Array.
OPTIONAL ITEMS:
DescriptionPart Numbe
r
Microlight Switch Qty:____I101769-99-0
Buddy Button Qty:____I101767-99-0
Egg Switch Black Qty: _____I106293-99-0
Mini Cup Switch Qty:____I101771-99-0
Proximity Switch Qty:____I107500-99-0
Mini Joyswitch 5 Switch OC for Omni - (9-pin)I107495-99-0
Dome Switch, Backrest Mnt w Gooseneck Qty: _____I10772
Mount on Left: _____ Mount on Right: _____
Mounts at top of backrest shell. Custom charge may be applied if ordering with short backrest
heights. Kit Includes: One PERMOfix joint with Flat Plate, two PERMOfix joints with 45° swivel
adjustment, one 150mm rod, one 200mm rod and one 225mm gooseneck switch with 1.2m
cable and mounting clamp.
Dome Switch, Backrest Swg Awy Mnt w Gsneck Qty:____I10846
Mount on Left: _____ Mount on Right: _____
w 90° Swing-Away Function. Mounts at top of back. Custom charge applies if ordered with
short back. Kit Includes: One PERMOfix joint with Flat Plate, one PERMOfix joint with 45°
swivel adjustment, two 6" rods, one 90° Swing-Away joint, one 9"
3.5mm Ext. Cable for Sensor/Switch, 0.3m LongI105935-99-0
3.5mm Ext. Cable for Sensor/Switch, 1m LongI105931-99-0
3.5mm Ext. Cable for Sensor/Switch, 2m LongI105932-99-0
Page 14 of 15
Rev 2020-1 08/17/2020
M300 Corpus HD
Alt Drive Accessories
OPTIONAL ITEMS:
DescriptionPart Numbe
r
3.5mm Ext. Cable for Sensor/Switch, 3m LongI105933-99-0
3.5mm Y-splitter Cable for Sensor/SwitchI105934-99-0
A
llows two Proximity Sensors/Mechanical Switches to connect to the same direction jack.
Chair Order Policy:
You are highly encouraged to contact Permobil Sales with ANY questions regarding proper completion of our order forms. The order cannot be processed
without the following:
-A client name or code, the client’s measurements, the client’s weight
-The order form must also be signed by a person authorized by your company to acknowledge the items selected. Permobil is not
responsible for configuration or size discrepancies resulting from customer errors on the order form.
-Order confirmations will be provided by Permobil summarizing the items selected. Please review this carefully.
-Once the order is shipped, any changes are subject to the returns policy and may be prohibited.
Order Acknowledgement:
I, _________________________, am an agent of the medical equipment provider named on this order form and I have the authority to contract for the
purchase of powered wheelchairs and related parts on behalf of said provider. I acknowledge that I have reviewed this order and that it is complete and
accurate to the best of my knowledge. I further acknowledge that any changes to this order after submission of this order form are subject to the returns policy
and may carry additional charges.
Signed:
Printed Name:
Title:
Date:
NOTE: All specifications and prices are subject to change without notice. Please note that prices displayed are only valid if ordered with the wheelchair. Any
parts ordered for service or future alterations will carry different pricing and warranty.
Page 15 of 15
Rev 2020-1 08/17/2020
Additional Order Instructions:
Please ensure an MK battery and Power First charger are supplied. (I107031-99-0 and I106583-99-0)
DO NOT SUPPLY THE PERMOBIL G24 BATTERY AND VOLTPRO BATTERY.
LAPSTACKER - Add an Adaptdefy LapStacker Set. There is only one configuration for Permobil Powerchairs.
Complete the LapStacker order form.
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Completed 16 January 2022

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