Permobil M300 Corpus 3G - User Manual

Prices effective November 4, 2013 and payable in Canadian dollars.
PO#:
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____________________________
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* Dealer Name:_____________________________
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Address:
_____________________________
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* Phone#:_____________________________
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* Contact:_____________________________
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* City:_____________________________
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* Fax#:_____________________________
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* Weight:______________________________
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*Height:______________________________
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A) Top of Shoulders:
______________________________
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B) Chest Depth:
______________________________
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C) Chest Width:
______________________________
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D) Seat Depth:
______________________________
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E) Top of Head:
______________________________
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F) Elbow to Hand:
______________________________
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G) Seat Pan to Elbow:
______________________________
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H) Hip Width:
______________________________
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*I) Knee to Foot:______________________________
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* Province
:
_____________________________
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Diagnosis:
_____________________________
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Dealer Information
Client Information
Client Measurements
Funding Source:
_____________________________
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Client Age:
_____________________________
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Dealer Code:
_____________________________
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* First Name:_____________________________
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* Last Name:_____________________________
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Email Address:
_____________________________
_
Permobil recommends that the client is evaluated by a
certified rehab specialist.
Please send order/quote to fax#: (800) 231-3256
Email to: sales@permobil.com
Display ADP Codes on order/quote:
M300 Corpus 3G
Three column pricing on order/quote:
Permobil Ltd.
4 - 75 Mary St.
Aurora, Ontario
L4G 1G3
Tel: (888) 726-9330
CAN Fax: (905) 726-9990
US Fax: (800) 231-3256
www.permobil.com

Permobil M300 Corpus 3G Specifications