Order form – Ombrelo™ Order number: Order Date:Company name / Name and surname Bill adress:* Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryE-mail:*Phone* Area Code - Phone Number Click if:shipping adress is the same as bill adressShip to: Shipment adress: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryContact: Area Code - Phone Number Ship product:*AssembledDissasembledProduct size / Upholstery colours:*size 2 / MOONsize 3 / SANDsize 4 / LOFTsize 5 / ONYXsize 2 / Green Grass (W)size 3 / Hot Red (W)size 4 / Brown Sugar (W)size 5 / Grey Vulcano (W)(W) AVAILABLE WHILE STOCK LASTSChoose upholstery:Standard equipmentLight foldable frame, folding in umbrella shapeWheels with glass fiber, front PU swivel, rear inflatable with 2 separate wheel brakesMulti-adjustable foot plates FlipFlap™ with 2 way feet stabilizing beltsSelf-tensioning upholstery Bodyprint™ for perfect positioningAdjustable seat depth5 points safety belts with height adjustmentSeat - 30° fixed tilt angleSeat to back 85° - 95° angle adjustmentAdjustable build up headrestBackrestAdjustable push handlesReflective safety marksTransFix™Upholstery Comfort™ – size 2 MOON,size 3 SAND, size 4 LOFT, size 5 ONYX.Upholstery Comfort™ – size 2 GREEN GRASS (W), size 3 HOT RED (W), size 4 BROWN SUGAR (W), size 5 GREY VULCANO(W)NEW: FLASH backpackAccessories:Safety:OMO_001 LED lights OMO_002 Belt for moving the patients AM-P (size 5)OMO_013 Safety railPositioning:OMO_101 Thigh abduction belts (size 0)OMO_101 Thigh abduction belts (size 1)OMO_101 Thigh abduction belts (size 2)OMO_101 Thigh abduction belts (size 3)OMO_107 Pelvic brace with pelvic beltOMO_113 Trunk stabilizing belt (size 2, 3)OMO_114 H Harness (I) (1)OMO_114 H Harness (A) (1)OMO_124 Loins supportOMO_125 6 points safety vest S (I) (1)OMO_125 6 points safety vest S (A) (1)OMO_125 6 points safety vest M (I) (1)OMO_125 6 points safety vest M (A) (1)OMO_125 6 points safety vest L (I) (1)OMO_125 6 points safety vest L (A) (1)OMO_125 6 points safety vest XL (I) (1)OMO_125 6 points safety vest XL (A) (1)OMO_128 Adjustable abduction block (2)OMO_130 4 points safety vest (instead)OMO_130 4 points safety vest (additional)OMO_162/1 Dynamic ankle stabilizers (FP-22)(size XS, perimeter of the ankle CM: 4 – 17 cm; IN: 6-7 in)OMO_162/2 Dynamic ankle stabilizers (FP-22)(size S, perimeter of the ankle CM: 16.5 – 20 cm; IN: 6-8 in)OMO_162/3 Dynamic ankle stabilizers (FP-22)(size M, perimeter of the ankle CM: 19 cm – 23.5 cm; IN: 7-9 in)OMO_162/4 Dynamic ankle stabilizers (FP-22)(size L, perimeter of the ankle CM: 23 cm – 28 cm; IN: 9-11 in)OMO_162/5 Dynamic ankle stabilizers (FP-22)(size XL, perimeter of the ankle CM: 26.5 cm – 33 cm; IN: 10-13 in)OMO_163/1 Anatomic thigh abduction belts (FP-23) (size M)OMO_163/2 Anatomic thigh abduction belts (FP-23) (size L)*OMO_170/1 Pelvis stabilizer (FP-16) (size S, pelvic width 19 - 25 cm, depth 18 cm, height 20 cm) (size 2)*OMO_170/2 Pelvis stabilizer (FP-16) (size M, pelvic width 25 - 31 cm, depth 21 cm, height 23 cm) (size 2, 3)*OMO_170/3 Pelvis stabilizer (FP-16) (size L, pelvic width 31 - 38 cm, depth 24 cm, height 25 cm) (size 3, 4, 5)*OMO_170/4 Pelvis stabilizer (FP-16) (size XL, pelvic width 38 - 45 cm, depth 30 cm, height 27 cm) (size 5)Comfort:OMO_402 Umbrella OMO_403 Tray (black color)OMO_405 Folding canopyOMO_408 Rain cover (5)OMO_411 Cup holderOMO_415 Rear wheels coverOMO_417 Winter footmuff with muffsOMO_433 Lifting barOMO_439 Hand brake (4)OMO_442 Front wheel coversOMO_447 Winter muffs**OMO_453 PA-VM-15 Cushion (Seat cushion with bolster)Storage:OMO_505 Under seat storage basketOMO_506 Carrier bag for the strollerOMO_507 Oxygen tank holder OMO_509 Organizer bagOMO_511 VOYAGER backpackOMO_512 FLASH backpackSpare parts:OMO_704 All Terrain wheels (I)OMO_704 All Terrain wheel (A)Additional upholstery:OMO_700 Upholstery HYDRO™ - SEA (I)OMO_700 Upholstery HYDRO™ - SKY (I)OMO_723 Upholstery COMFORT™ - ALOE (I)OMO_723 Upholstery COMFORT™ - ROSE (I)* SUGGESTED SIZES. MORE DETAILS ON WWW.FLEX-POINT.PL/EN** IT IS NOT POSSIBLE TO USE THE ADJUSTABLE ABDUCTION BLOCK WHILE USING THE SEAT CUSHION WITH BOLSTER.(C) CUSTOM-MADE. LEAD TIME ca. 30 DAYS.(1) H HARNESS, 4 POINTS AND 6 POINTS SAFETY VESTS SHOULD BE USED WITH _101, _128 OR _163.(2) 5 POINTS SAFETY BELTS ARE NOT AVAILABLE WITH _128. PLEASE CHOOSE _114 OR _130 INSTEAD, FREE OF CHARGE. PLEASE CHOOSE _125 INSTEAD, ADDITIONAL CHARGE 30 EUR.(3) OVERALL WIDTH OF THE HEADREST IN SIZE 1 – 23 CM, SIZE 2 – 26 CM, SIZE 3 – 30 CM.(4) THERE IS AN OPTION TO PURCHASE THE STROLLER WITH BRAKE LEVER (MARK ELEMENT _439). THERE IS NO POSSIBILITY TO ASSEMBLE BRAKE LEVER SINGLE-HANDEDLY LATER. LEAD TIME CA. 30 DAYS.(5) TO MOUNT THE RAIN COVER AND MOSQUITO NET ON THE STROLLER, IT IS NECESSARY TO MOUNT THE FOLDING CANOPY FIRST. THE FOLDING CANOPY IS NOT A STANDARD EQUIPMENT.(6) COVER FITS THE STANDARD OMBRELO HEADREST ONLY.(7) LEAD TIME CA. 30 DAYSMessage to us:SubmitReset
