Fillable TiLite X-Series Order Form (Accident Compensation Corporation New Zealand)

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TiLite X-Series Order Form (Accident Compensation Corporation New Zealand)

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Page 1 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
DEALER INFORMATION
RTS INFORMATION
Dealer:
Account #:
RTS:
Phone:
PO: Ordered By: Email:
Email:
SHIP TO INFORMATION
Mark For: User Weight: Name: Ship Via:
TiLite Sales Rep: Address:
TiLite Information:
Promo Code:
City:
State:
Ship Date: Order #: Phone: Fax:
More options and frame modifications may be available through our Creative Mobility Division! Please click here to view options.
Please email sales.nz@permobil.com
FRAME STYLE
AXFS1 ❑ Aero X2 Aluminum Frame (Full Adjustability. 120.2kg Weight Limit.)
G2FS1 ❑ 2GX2 Titanium Frame (Full Adjustability. 120.2kg Weight Limit. Light Weight, High Strength and Vibration Dampening.
Not Available with Frame Transit Tie-Down.)
XFS1 ❑ Swing Away STD
XFS3 ❑ Hemi Height Frame (Available with a Front Seat Height of 13.5” - 20” (34.3-50.8cm). Not Available with Depth Adjustable
Back/Frame, 12” or 13” (30.5cm or 33cm) Seat Depth or Heavy Duty Frame.) NCO
XFS2 ❑ Fixed Front NCO
SM-MX2-168 ❑
SmartDrive MX2+
(Please supply the SmartDrive MX2+ order form)
X
HDR1
❑ Heavy Duty Frame (158.8kg Weight Limit. Includes Tension Adjustable by Straps Back Upholstery.
Available with 18” to 22” (45.7 to 55.9cm) Seat Widths & 16” to 20” (40.6 to 50.8cm) Seat Depths. Not Av
ailable with 90° front end)
XRFR1 ❑ Reinforced Frame (No charge when 20” (50.8cm) Rear Seat Width and 20” (50.8cm) Seat Depth are selected.)
TRANSIT OPTIONS
(Please refer to the Aero X2 Transit Tie-Down Option Brochure for important information regarding the Transit Tie-Down Options.)
XTTDO1 ❑ Aluminum Frame Transit Tie-Down (Consists of four Tie-Down Brackets. Not Available with 2GX2, Heavy Duty Frame, Hemi
Height Frame, Folding Adjustable-Angle and Height Seat Back, Depth Adjustable Back/Frame, Swing Away Tubular Armrests or
Swing Away - Flip Back Tubular Armrests. Requires a Folding Stabilizer Bar. Requires minimum seat depth of 14” (35.6cm))
XWTB ❑ Transport Bracket Option (Consists of four Tie-Down Brackets. Unoccupied Use Only.) (Not Available when Swing Away
frame and Heavy Duty Frame are both selected. Not available with Swing Away Tubular Armrest or Swing Away - Flip Back
Tubular Armrests. Requires a minimum seat depth of 14” (35.6cm) or 15” (38.1cm) seat Depth with Hemi Height Frame.)
FRAME FINISHES
Natural Finishes
XFF1 ❑ Satin (Available with Titanium Frame only.) STD
XSCBT1 ❑ Satin Finish Buffing Pads
XFF3 ❑ Tattoos (Tattoos on front frame tubes. Titanium frame finished in Satin Aluminum frame finished in blasted aluminum with clear coat.
Tattoos will be trimmed and adjusted to fit your frame.)
XFF45 ❑ Need For Speed XFF44 ❑ Flower Garden
XFF43 ❑ Mosaic
High Gloss Paint
Metallic Paint
Pearlescent Paint
❑ XFF8 High Gloss Black
❑ XFF14 Ocean Blue Metallic
❑ XFF17 Midnight Blue Pearl
❑ XFF10 TiLite Red
❑ XFF15 Tangerine Metallic
❑ XFF18 White Pearl
❑ XFF29 Neon Pink
❑ XFF30 Acid Green Metallic
Matte Paint
❑ XFF19 Black Lava
❑ XFF27 Titanium Grey
Candy Paint
❑ XFF22 Ruby Red
❑ XFF23 Azure Blue
❑ XFF25 Electric Plum
Textured Matte Paint
❑ XFF40 Hyper Blue
❑ XFF41 Flame Orange
❑ XFF42 OD Green
STD
FRAME MEASUREMENTS
SEAT WIDTH A Measure from outside of seat tube at back post to the outside of the opposite seat tube at back post.
XSW1 ❑ 12” (30.5cm) ❑ 13” (33cm) ❑ 14” (35.6cm) ❑ 15” (3.1cm) ❑ 16” (40.6cm) ❑ 17” (43.2cm) ❑ 18” (45.7cm)
❑ 19” (48.3cm) STD
XSW2 ❑ 20” (50.8cm) ❑ 21” (53.3c
m) ❑ 22” (55.9cm) (21” (46cm) and 22” (56cm) Seat Widths A are only available with Heavy Duty Frame.)
Permobil New Zealand Ltd
181A McLeod Road, Te Atatu South, 0610
0800 115 222 | sales.nz@permobil.com | permobil.com/en-nz
Page 2 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
SEAT DEPTH B Measure from 1/2” (1cm) in front of back post to the front edge of seat sling. (12”-14” (30-35.6cm) Seat Depths B not
available with 25” and 26” Rear Wheels.)
XSD1 ❑ 12” (30.5cm) ❑ 13” (33cm) ❑ 14” (35.6cm) ❑ 15” (38.1cm) ❑ 16” (40.6cm) ❑ 17” (43.2cm)
❑ 18” (45.7cm) ❑ 19” (48.3cm) STD
XSD2 ❑ 20” (50.8cm)
XSD3 ❑ Custom Frame Depth: ” Frame Depth Longer Than Seat Depth (Use 1” (2.5cm) increments with a maximum
of 2” (5.1cm). A Custom Frame Depth with a maximum of 20” (50.8cm) is $537) NCO
FRONT SEAT HEIGHT C Measure from floor to top of seat tube at front edge of seat sling Adjustable in ½” (1.3cm) increments.
(13.5” - 14” (34.3-35.6cm) Front Seat Height C requires Hemi Height Frame Style. 20.5” - 21” (52.1-53.3cm) Front Seat Height C not available with
Hemi Height Frame Style
.
FRONT SEAT HEIGHT RANGES
XFSH1 ❑ 13.5” (34.3cm) ❑ 14” (35.6cm) ❑ 14.5” (36.8cm)
❑ 15” (38.1cm) ❑ 15.5” (39.4cm) ❑ 16” (40.6cm)
❑ 16.5” (41.9cm) ❑ 17” (43.2cm) ❑ 17.5” (44.5cm)
❑ 18” (45.7cm) ❑ 18.5” (47cm) ❑ 19” (48.3cm)
❑ 19.5” (49.5cm) ❑ 20” (50.8cm) ❑ 20.5” (52.1cm)
❑ 21” (53.3cm) STD
REAR SEAT HEIGHT D Measure from floor to top of seat tube at back post. Adjustable in 3/8” increments.
REAR SEAT HEIGHT RANGES
Rear Wheel Size Rear Seat Height D
XRSH1 ❑ 13” (33cm) ❑ 13.5” (34.3cm) ❑ 14” (35.6cm)
❑ 14.5” (36.8cm) ❑ 15” (38.1cm) ❑ 15.5” (39.4cm)
❑ 16” (40.6cm) ❑ 16.5” (41.9cm) ❑ 17” (43.2cm)
❑ 17.5” (44.5cm) ❑ 18” (45.7cm) ❑ 18.5” (47cm)
❑ 19” (48.3cm) ❑ 19.5” (49.5cm) ❑ 20” (50.8cm) STD
SEAT BACK HEIGHT E/SEAT BACK/PUSH HANDLES Measure from top of back post to top of seat tube at rear of frame.
SEAT BACK TYPE
XSB13 ❑ Fixed Angle, Adjustable-Height Seat Back STD
XLB1 ❑ Folding Stabilizer Bar (Required with Transit Tie-Down Option unless Depth Adjustable Backrest is selected.
Includes Tension Adjustable by Strap Back Upholstery.)
XSB14 ❑ Fixed Angle, Adjustable Height Seat Back w/8-Degree Bend (Not available with Heavy Duty Frame.)
XSB18 ❑ Folding Adjustable-Angle and Height Seat Back (Not Available with Hemi Height Frame, Heavy Duty Frame, 19” or 20”
(48.3 or 50.8cm) Seat Depths B or Swing Away Tubular Armrest. Seat Depths B of 12”-17” (30.5-43.2cm) allow 3” (7.6cm) of
rearward adjustment. Seat Depth B of 18” (45.7cm) allow 2” (5.1cm) of rearward adjustment.
Requires Tension Adjustable Seat
Upholstery)
XSB16 ❑ Depth Adjustable Back/Frame (Not Available with Hemi Height Frame, Heavy Duty Frame, 19” or 20”
(48.3 or 50.8cm) Seat Depths B, Swing Away Tubular or Swing Away Flip-Back Armrest. Seat Depths B of 12”-17” (30.5-43.2cm)
allow 3” (7.6cm) of rearward adjustment. Seat Depth B of 18” (46cm) allow 2” (5cm) of rearward adjustment.
Requires Tension
Adjustable Seat Upholstery)
PUSH HANDLES
XSB6 ❑ Integrated Push Handles NCO
XSB7 ❑ Integrated Fold-Down Push Handles (Requires Tension Adjustable by Straps Back Upholstery. Not available with
Heavy Duty Frame.)
A
F
E
B
H
D
C
I
22”
24”
25”
26”
13” - 18” (33-45.7cm)
14”
- 19” (35.6-48.3cm)
14”
- 19” (35.6-48.3cm)
15” - 20” (38.1-50.8cm)
Front Wheel Size
Front Seat Height C
Hemi Front Seat Height C
3” Front Wheel
14.5” – 18.5”
13.5” – 17.5”
3” Front Wheel w/ Glide
TM
16.5” – 17.5”
15.0” – 17.0”
4” Front Wheel
15.5” – 19.0”
14.5” – 18.0”
4” Front Wheel w/ Glide
TM
17.0” – 18.0”
15.5” – 17.0”
5” Front Wheel
16.5” – 19.5”
16.0” – 18.5”
5” Front Wheel w/ Glide
TM
17.5” – 18.5”
16.5” – 18.0”
6” Front Wheel
17.5” – 20.0”
16.5” – 19.0”
6” Front Wheel w/ Glide
TM
19.0”
17.5” – 18.0”
8” Front Wheel
19.5” – 21.0”
18.5” – 19.5”
Page 3 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
X
SB9 ❑ Bolt-On Height Adjustable Push Handles
(Requires Tension Adjustable by Straps Back Upholstery. Not available with Heavy
Duty Frame, Folding Adjustable-Angle and Height Seat Back, Swing Away Tubular Armrests, Swing Away - Flip Back
Tubular Armrests
XSB13/XSB14 FIXED ANGLE ADJUSTABLE SEAT BACK HEIGHT E (11”- 15” Fixed Seat Back Height not available with Heavy Duty
Frame, Swing Away Tubular Arms 12”-15”, Bolt-On Adjustable Height Push Handles or Folding Stabilizer Bar.)
Push Handles (Selected Above) Short Tall Set at: (Use 1” increments)
XSB18 FOLDING ADJUSTABLE- ANGLE AND HEIGHT SEAT BACK E (Not available with a Folding Stabilizer Bar or Heavy Duty Frame.)
Push Handles (Selected Above) Short Medium Tall Set at: (Use .5” increments)
CAMBER F
XCBR8 ❑ 0° ❑ 2° ❑ 4° ❑ 6° STD
FRONT ANGLE H Front Angle H is measured from inside of front frame tube to top of bottom frame tube.
Swing Away Front End
XFA3 ❑ 70° ❑ 80° ❑ 85°
(Not available with 6” Front Wheels.) ❑ 90° (Requires aluminum footplate. Not available with
Heavy Duty Frame, 5” or 6” Front Wheels.) STD
XFA0 ❑ Omit Hangers NCO
Fi
xed Front End
XFA6 ❑ 70° ❑ 80° ❑ 85° (85° Not available with 6” Front Wheels) STD
SEAT TO FOOTREST I/FOOTRESTS Measure from front edge of seat sling to top rear of footrest.
If your Front Angle H is 70°, 80° OR 85° select one Seat to Footrest I length and one Footrest type:
Standard Footrests Measurement must be at least 2” shorter than Front Seat Height C. 70° Fixed Front has a minimum seat to footrest
of 14.5”
❑ 14” (35.6cm) ❑ 14.5” (36.8cm) ❑ 15” (38.1cm) ❑ 15.5” (39.4cm) ❑ 16” (40.6cm) ❑ 16.5” (41.9cm) ❑ 17” (43.2cm)
❑ 17.5” (44.5cm) ❑ 18” (45.7cm) ❑ 18.5” (47cm) ❑ 19” (48.3cm) ❑ 19.5” (49.5cm) ❑ 20” (50.8cm)
XFTR5 ❑ Flip-up Footrest STD
XFTR9 ❑ Depth Adjustable Flip-up Footrest
XFTR10 ❑ Depth & Angle Adjustable Flip-up Footrest (Available for 15”- 20” (38.1-50.8cm) Seat to Footrest I only.)
XFTR11 ❑ Angle Adjustable Flip-up Footrest (Available for 15”- 20” (38.1-50.8cm) Seat to Footrest I only.)
High Mount Footrests (Not Available with Luggage Carriers, or Impact Guards)
❑ 7” (17.8cm) ❑ 7.5” (19.1cm) ❑ 8” (20.3cm) ❑ 8.5” (21.6cm) ❑ 9” (22.9cm) ❑ 9.5” (24.1cm) ❑ 10” (25.4cm) ❑ 10.5” (26.7cm)
❑ 11” (27.9cm) ❑ 11.5” (29.2cm) ❑ 12” (30.5cm) ❑ 12.5” (31.8cm) ❑ 13” (33cm) ❑ 13.5” (34.3cm) ❑ 14” (35.6cm)
❑ 14.5” (36.8cm)
XFTR20 ❑ High Mount Flip-up
XFTR15 ❑ Angle Adjustable High Mount Flip-up Footrest
XFTR16 ❑ Depth & Angle Adjustable High Mount Flip-up Footrest
If your Front Angle H is 90°, select one Seat to Footrest I length and one Footrest type:
❑ 7” (17.8cm) ❑ 8” (20.3cm) ❑ 9” (22.9cm) ❑ 10” (25.4cm) ❑ 11” (27.9cm) ❑ 12” (30.5cm) ❑ 13” (33cm)
XFTR5 ❑ Flip-up Footrest STD
XFTR9 ❑ Depth Adjustable Flip-up Footrest
XFTR10 ❑ Depth & Angle Adjustable Flip-up Footrest
XHLP1 ❑ Heel Loops (Not available with 13” (33cm) or narrower Seat Width A)
CUSTOM CONFIGURATION OPTIONS
FRONT WHEELS (See Front Seat Height Ranges Chart on Page 2 for Front Seat Height C limitations.)
XFW24 ❑ 3”x1.5” LiteSpeed Billet Aluminum Wheel w/Soft Roll Tire ❑ Silver Hub OR ❑ Black Hub
None
❑
11”- 15”
(27.9-38.1cm) ❑
16”- 20”
(40.6-50.8cm)
Set at:
Integrated ❑ 11”- 15” (27.9-38.1cm) ❑ 16”- 20” (40.6-50.8cm) Set at:
Integrated Fold-Down ❑ 11”- 15” (27.9-38.1cm) ❑ 16”- 20” (40.6-50.8cm) Set at:
Bolt-On Height Adj.
❑
16”- 20” (40.6-50.8cm) Set at:
None
Integrated
❑ 11”- 13” (27.9-33cm)
❑ 13.5”- 16.5” (34.3-41.9cm) ❑ 16.5”- 19.5” (41.9-49.5cm)
❑ 12.5”- 14.5” (31.8-36.8cm) ❑ 13.5”- 16.5” (34.3-41.9cm) ❑ 17”- 19.5” (43.2-50.8cm)
Integrated Fold-Down ❑ 15”- 17” (38.1-4.2cm) ❑ 16”- 19” (40.6-48.3cm) ❑ 18.5”- 20.5” (47-52.1cm)
Set at:
Set
at:
Set at:
Page 4 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
X
FW14 ❑ 4”x.75” Plastic Wheel w/Poly Tire
(Not available with Power Adaptable Frame, Heavy Duty Frame or Glide
™
Single-Sided
Suspension Fork.) NCO
XFW3 ❑ 4”x.75” Light-Up Micro-Caster (Not available with Power Adaptable Frame, Heavy Duty Frame or Glide
™
Single-Sided
Suspension Fork.)
XFW26 ❏ 4”x1.5” LiteSpeed Plastic Wheel w/Soft Roll Tire (Not available with Power Assist, Power Add-on System or Heavy Duty Frame.)
XFW27 ❑ 4”x1.5” LiteSpeed Billet Aluminum Wheel w/Soft Roll Tire ❑ Silver Hub OR ❑ Black Hub
XFW6 ❑ 5”x1” Plastic Wheel w/Poly Tire (Not available with Heavy Duty Frame or with 90º Front Angle H or Glide
™
Single-Sided
Suspension Fork.) NCO
XFW28 ❏ 5”x1.5” LiteSpeed Plastic Wheel w/Soft Roll Tire (Not available with Power Adaptable Frame, Heavy Duty Frame or
90º Front Angle H.)
XFW30 ❑ 5”x1.5” LiteSpeed Billet Aluminum Wheel w/Soft Roll Tire ❑ Silver Hub OR ❑ Black Hub (Not available with
90º Front Angle H.)
XFW9 ❑ 6”x1” Plastic Wheel w/Poly Tire (Not available with Power Adaptable Frame, Heavy Duty Frame or 85º or
90º Front Angle H or Glide
™
Single-Sided Suspension Fork.) NCO
XFW32 ❑ 6”x1.5” LiteSpeed Plastic Wheel w/Soft Roll Tire (Not available with Power Adaptable Frame, Heavy Duty Frame,
85º or 90º Front Angle H, or Glide
™
Single-Sided Fork)
XFW33 ❑ 6”x1.5” LiteSpeed Billet Aluminum Wheel w/Soft Roll Tire ❑ Silver Hub OR ❑ Black Hub (Not available with
85º or 90º Front Angle H or Glide
™
Single-Sided Suspension Fork.)
X2FW16 ❑ 8”x1” Plastic Wheel w/Poly Tire (Not available with Power Assist, Power Add-on, Heavy Duty Frame or Glide
™
Single-Sided
Available with 70º Front Angle H only.) (Not available with 12”-14” Seat Depths) NCO
FRONT FORKS
XFK1 ❑ TiLite Standard Fork STD
XGL1 ❑ Out-Front Glide
™
Suspension Fork (Available in Black anodize only. Not available with 8” Front Wheels or Heavy Duty Frame)
Rider’s Weight: ❑ 125 lbs. (56.69kg) ❑ 125-180 lbs.(56.69-81.64kg) ❑ 180-265 lbs. (81.64-120.2kg)
ONE ARM DRIVE
XOAD1 ❑ One Arm Drive (Available with 24” Mag Wheels only. Rear Seat Height, Camber or axle restrictions may apply.)
Drive Handrim Side (Available with standard aluminum handrim only.)
❑ Install on Left ❑ Install on Right
STANDARD REAR WHEELS (See Rear Seat Height Ranges Chart on Page 2 for Rear Seat Height D limitations.)
XRW14 TiLite SHADOW
TM
STD
❑ 22”(501)
❑ 24”(540)
❑ 25”(559)
(Requires 15” (38.1cm) minimum Seat Depth B.)
❑ 26”(590) (Requires 15” (38.1cm) minimum Seat Depth B.)
PERFORMANCE REAR WHEELS (See Rear Seat Height Ranges Chart on Page 2 for Rear Seat Height D limitations.)
XRW7 Spinergy SPOX ❑ Black ❑ Red ❑ Blue ❑ White
❑ 22”(501) - Std. Hub
❑ 24”(540) - Std. Hub
❑ 25”(559) - Std. Hub
(Requires 15” (38.1cm) minimum Seat Depth B.)
❑ 26”(590) - Std. Hub (Requires 15” (38.1cm) minimum Seat Depth B. Not available with Quad Release Axles.)
XRW8 Spinergy LX (Only available with Heavy Duty Frame when 0 or 2 degree camber is selected.) ❑ Black ❑ Red ❑ Blue
❑ White ❑ Bright Orange ❑ Flamingo Pink
❑ 22”(501) - Std. Hub
❑ 24”(540) - Std. Hub
❑ 25”(559) - Std. Hub
(Requires 15” (38.1cm) minimum Seat Depth B.)
❑ 26”(590) - Std Hub (Requires 15” (38.1cm) minimum Seat Depth B. Not available with Quad Release Axles.)
XRW9 New Spinergy Design Lab LX (If same colour is selected, anodized hubs and rims match colour anodized packaged on page 1.
Available with black spokes only)
❑ Gold Anodize ❑ Green Anodize ❑ Blue Anodize ❑ Red Anodize ❑ Purple Anodize
❑ Orange Anodize
❑ 22”(501) - Std. Hub
❑ 24”(540) - Std. Hub
❑ 25”(559) - Std. Hub
(Requires 15” (38.1cm) minimum Seat Depth B.)
❑ 26”(590) - Std Hub (Requires 15” (38.1cm) minimum Seat Depth B.)
XRW16 New Spinergy Carbon Blade with 3K Weave Carbon Fiber (Not available with Heavy Duty Frame.)
❑ 24”(540)
❑ 25”(559)
(Requires 15” (38.1cm) minimum Seat Depth B.)
XRW17 X-Core Mag (Not available with Heavy Duty Frame, Short Tabs, Quad Release Axles, Spoke Guards or Omit Handrims Option Requires Aluminum
Sliver Anodized Handrims. Only available with Treaded, Treaded with Airless Insert, Kenda Kobra, Primo Active and Primo Express tires.)
❑ 22”(501)
❑ 24”(540)
Page 5 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
AXLES
XAXL1 ❑ Stainless Quick Release STD
XAXL2 ❑ Titanium Quick Release
XAXL3 ❑ Quad Release (Not available with Mag or 26”(590) Spinergy Spox or Spinergy LX Rear Wheels.)
PNEUMATIC REAR TIRES
XRTR1 ❑ Treaded (Not available with 25”(559) Rear Wheels.) STD
XRTR2 ❑ Airless Inserts
XRTR31 ❑ 20”(451), 22”(501), 24”(540), 25”(559) and 26”(590) New MBL SpeedLite STD
XRTR30 ❑ 24”(540), 25”(559) and 26”(590) Primo Sentinel
XRTR8 ❑ 24”(540), 25”(559) and 26”(590) Schwalbe
®
Marathon Plus Evolution
XRTR24 ❑ 24”(540) Kenda Kobra Knobby Tires
SOLID REAR TIRES
XRTR22 ❑ 22”(501), 24”(540) and 25”(559) Primo Express (Not available with Spinergy Carbon Blade Rear Wheels.)
XRTR23 ❑ 24”(540) and 25”(559) Primo Active
HANDRIMS
Handrims by OUT-FRONT
®
XRIM1 ❑ Aluminum – Silver Anodized STD
XRIM21 ❑ Aluminum – Black Anodized
XRIM12 ❏ Titanium – Satin Finish (Not available with 20”(451) or 22”(501) Rear Wheels, or 24”(540) Knobby tires.)
XRIM10 ❑ The Surge (All-In-One Oval with Gription
™
Strip, Larger Profile)
XRIM11 ❑ The Surge LT (All-In-One Oval with Gription
™
Strip, Smaller Profile)
XRIM20 ❑ Q-Grip (Exclusive High-Friction, Anti-Slip Coating)
The Natural-Fit
®
(Original, Larger Profile)
XRIM14 ❑ Standard Grip (Not available with Short Tabs or Spinergy Carbon Blade Rear Wheels.)
XRIM15 ❑ Super Grip (Not available with Short Tabs or Spinergy Carbon Blade Rear Wheels.)
XRIM16 ❑ Without Thumb Grip
The Natural-Fit
®
LT (Reduced Weight, Smaller Profile)
XRIM17 ❑ Standard Grip (Not available with Short Tabs or Spinergy Carbon Blade Rear Wheels.)
XRIM18 ❑ Super Grip (Not available with Short Tabs or Spinergy Carbon Blade Rear Wheels.)
XRIM19 ❑ Without Thumb Grip
Additional Handrim Options
XRIM5 ❑ Plastic Coated – Black
XRIM22 ❑ Omit Handrims NCO
Tab Length
XRIM7 ❑ Long Tabs STD
XRIM8 ❑ Short Tabs (Not available with Mag Rear Wheels or The Natural-Fit
®
Handrims with Thumb Grip.)
WHEEL LOCKS
Wheel Locks by OUT-FRONT
®
(Composite wheel locks not always compatible with 12”-13” (30-33cm) Seat Depth. Uni-locks will be
substituted at no charge.)
XWLK7 ❑ Compact Composite Push to Lock NCO
XWLK8 ❑ Compact Composite Pull to Lock NCO
XWLK10 ❑ Extension Handles for Compact Composite Push/Pull to Lock
Additional Wheel Locks
XWLK11 ❑ New MBL Composite Scissor Lock (Not available on swing away frame.)
XWLK3 Uni-Lock Set At: ❑ Push OR ❑ Pull
XWLK4 ❑ Extension Handles for Uni-Lock
XWLK15 ❑ Grade Aids Push to Lock (Not available with solid rear tires)
BACK UPHOLSTERY
XBUP1 ❑ Padded Nylon
(Black Only. Not available with Heavy Duty Frame, Folding Back, Folding Stabilizer Bar, Depth Adjustable Frame,
Fold-Down Push Handles or Ultrasuede Backrest Stripe.) STD
Tension Adjustable by Straps (Included with Heavy Duty Frame. Required with Aluminum Fendered Side Guards and Fold-Down Push Handles.)
XBUP3 ❑ Padded Nylon
XBUP5 ❑ AIR Breathable Upholstery (Not available with Ultrasuede Backrest Stripe.)
XUPC3 Ultrasuede Backrest Stripe ❑ Black
XBUP0 ❑ Omit Back Upholstery NCO
Page 6 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
BACK SUPPORTS
AE-BSxWxL ❑ Comfort Acta-Embrace
(Available on 12” to 20” seat widths. Includes 2-point compass cane mount hardware)
Back support length: ❑ 10” (25.5cm) ❑ 12” (30.5cm) ❑ 14” (35.6cm) ❑ 16” (40.6cm)
R-AGx-xxAL-0 ❑ ROHO Agility (Available on 14” to 20” seat widths. Includes quick release hardware)
Contour: ❑ AG2 ❑ AG3
Back support length: ❑ 10” (25.5cm) ❑ 13” (33cm) ❑ 16” (40.6cm)
SEAT UPHOLSTERY
XSUP4 ❑ Tension Adjustable (Black only) STD
XSUP0 ❑ Omit Seat Upholstery NCO
SEAT CUSHION
CU-SV-xx ❑ Comfort Curve
M2-FQA-xx ❑ Comfort M2 Anti-Thrust
EM-FQA-xx ❑ Comfort Acta-Embrace Anti-Thrust
R-ALxxHD ❑ ROHO AirLite
R-1RxxLPC ❑ ROHO Single Valve, Low Profile
R-1RxxH-CA-SR ❑ ROHO Single Valve, High Profile, Sensory Ready
R-QSxxLPC ❑ ROHO Quadtro Select, Low Profile
R-QSxxC ❑ ROHO Quadtro Select, High Profile
R-1RHExxC-SR ❑ ROHO Hybrid Elite, Single Valve, Sensory Ready
SIDE GUARDS
Aluminum
XSDG2 ❑ Rigid Removable ❑ Small OR ❑ Std
XSDG3 ❑ Quad Removable w/Hole ❑ Small OR ❑ Std
XSDG6 ❑ Fendered Adjustable (Requires Tension Adjustable by Straps Back Upholstery. Not available with Angle-Adjustable
Fold-Down Seat Backs.)
New 3K Weave Carbon Fiber
XSDG7 ❑ Rigid Removable ❑ Small OR ❑ Std
XSDG8 ❑ Quad Removable w/Hole ❑ Small OR ❑ Std
XSDG11 ❑ Fendered Adjustable (Requires Tension Adjustable by Straps Back Upholstery. Not available with Angle-Adjustable
Fold-Down Seat Backs.)
ARMRESTS (Desk Arms come with built-in Side Guards.)
XARM1 Swing Away Tubular (Not available with Heavy Duty Frame, Folding Stabilizer Bar with Short or Medium Seat Back
Height ranges or Depth Adjustable Back.) STD
❑ 9” - 12” (22.9 to 30.5cm) OR ❑ 12” - 15” (30.5 to 38.1cm)
XARM4 ❑ Swing Away - Flip Back Tubular (Not available with Heavy Duty Frame, Folding Stabilizer Bar or Depth Adjustable Back.)
XARM2 Removable Height Adjustable Desk Arm with Rigid Side Guard (Requires 14” minimum Seat Depth B.)
❑ 9” to 12” (22.9 to 30.5cm) OR ❑ 12” to 15” (30.5 to 38.1cm)
❑ Standard Length Pad (10” (25.5cm)) OR ❑ Full Length Pad (14” (35.5cm))
XARM3 Removable Height Adjustable Desk Arm with Rigid Side Guard and Transfer Loop
(Requires 16” minimum Seat
Depth B.)
❑ 9” to 12” (22.9 to 30.5cm) OR ❑ 12” to 15” (30.5 to 38.1cm)
❑ Standard Length Pad (10” (25.5cm)) OR ❑ Full Length Pad (14” (35.5cm))
Available Armrest Option
XARM5 ❑ Covered in Black Ultrasuede (Not available with Desk Arms)
SEA
T BELTS
XBLT1 ❑ Velcro Adjustable, Black Nylon Webbing
BP-HB205-M46-B1 ❑ Bodypoint
®
Two-Point Padded Hip Belt, Centre Pull with Push-Button Buckle, Medium
BP-HB205-L62-B1 ❑ Bodypoint
®
Two-Point Padded Hip Belt, Centre Pull with Push-Button Buckle, Large
BP-EB205-M46-B1 ❑ Bodypoint
®
EvoFlex
®
Pelvic Stabilizer, Centre Pull with Push Button Buckle, Medium
BP-EB205-L62-B1 ❑ Bodypoint
®
EvoFlex
®
Pelvic Stabilizer, Centre Pull with Push Button Buckle, Large
BP-HW320-25-2 ❑ Bodypoint
®
Optional Band Clamp Mounting Hardware
CALF STRAP
XCLF2 Velcro Adjustable
❑ Small (Recommended for 9”- 12” (22.9-30.5cm) Footrest Widths)
❑ M
edium
(Recommended for 11”- 15” (27.9-38.1cm) Footrest Widths)
Page 7 of 7
Effective October 2021 (New Items in Red)
TiLite X-Series Order Form
FOLDING FRAME
❑ Lar
ge
(Recommended for 14”- 17” (35.6-43.2cm) Footrest Widths)
❑ X
tra Large
(Recommended for 16”- 19” (40.6-48.3cm) Footrest Widths)
BP-SP102x Bodypoint
®
Padded Velcro Adjustable
❑ Small (Recommended for 8”- 11” Footrest Widths.)
❑ M
edium
(Recommended for 11”- 15” Footrest Widths.)
❑ Lar
ge
(Recommended for 16”- 19” Footrest Widths.)
XCLF1 ❑ Buckle Adjustable, Black Nylon Webbing
RESIDUAL LIMB SUPPORT
XRSL1 ❑ Residual Limb Support (8” width x 10” length)
XRSL2 ❑ Residual Limb Support Pair (8” width x 10” length)
BACKPACK
XBCK3 ❑ Black Permobil Backpack
SEAT POUCH
XPCK3 ❑ Black Permobil Seat Pouch
BP-SP001 ❑ Bodypoint
®
Mobility Bag
SPOKE GUARDS
XGRD1 ❑ Clear with TiMotion Logo (Not available with Mag Rear Wheels.)
ANTI-TIPS
XTIP1 ❑ Rear Aluminum - Black
XTIP7 ❑ Black Aluminum Single
Mount on ❑ Left Side or ❑ Right Side NCO
XTIP2 ❑ User Friendly Flip-up
XTIP8 ❑ User Friendly Flip-up Single
Mount on ❑ Left Side or ❑ Right Side NCO
XTIP9 ❑ Tip Assist
ACCESSORIES
XUEST1 Upper Extremity Support Tray ❑ 12” to 14” (30.5-35.6cm) OR ❑ 13” to 15” (33-38.1cm) Seat Widths A
(Requires Armrests.)
XLUG1 ❑ Luggage Carriers (Not available with High Mount Swing Away Footrests or 1-Piece Flip-up Footrest.)
XMPCT2 Neoprene Impact Guards with Ultrasuede Stripe (Not available with High Mount Footrests, 90° Hangers or Elevating Leg Rest.)
❑ Black
XCH1 ❑ Crutch Holder
NOTES
GENERAL
More options and frame modifications may be available through our Creative Mobility Division! Please contact customer service for details or click here to view options.
Permobil manufactures TiLite manual wheelchairs in a wide variety of configurations to meet the varied needs of wheelchair users. The final selection of a particular model, its options
and accessories, and its measurements rests solely with the wheelchair user and advising healthcare professional. These wheelchairs must be fitted by a qualified healthcare
professional. HCPCS Codes are for reference purposes only. Actual coding and coverage varies by payer. Proper HCPCS coding is not a guarantee of payment. Please verify the
appropriate payer’s coverage policy.
Get the latest order forms at permobilus.com. Prices, standard features, options and accessories are subject to change without notice. All rights reserved. Trademarks are identified
by symbols™ and ®. TiLite, TiFit, the TiLite logo, Ti, the Ti logo, and TiShaft are registered trademarks of TiSport, LLC and are licensed to Permobil. Permobil
®
is a registered trademark
of Permobil. Adobe
®
, Acrobat
®
, Acrobat Professional
®
and Reader
®
are registered trademarks of Adobe Systems Inc. Bodypoint
®
is a registered trademark of Bodypoint Inc. Kenda
®
is a
registered trademark of Kenda Rubber Industrial Co. Ltd. ROHO
®
, AGILITY
®
, Low Profile
®
and Quadtro Select
®
are registered trademarks of ROHO Inc. Schwalbe
®
is a registered
trademark of Ralf Bohle GmbH. The Natural-Fit
®
and Out-Front
®
are registered trademarks of Three Rivers Holdings, LLC. The ACTA-BACK
®
, ACTA-EMBRACE™, COMFORT-TEK™,
COMPASS
®
, CURVE
®
, ELEMENTS
®
, and STRETCH AIR™ are registered trademarks of THE COMFORT COMPANY
®
and are licensed to Permobil. Q’Straint
®
is a registered trademark
of Q’Straint Inc.
Add a Adaptdefy LapStacker Set (each set comprises of - one retractor, buckle, clamp, bracket and keeper set).
Complete the LapStacker order form.
LAPSTACKER
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TiLite X-Series Order Form (Accident Compensation Corporation New Zealand)

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Completed 13 January 2022

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