Order form – Zebra

Order number:
Order Date:
Company name / Name and surname
Bill adress:*
E-mail:*
Phone*
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Click if:
Ship to:
Shipment adress:
Contact:
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Ship product:*
Product size*

Choose upholstery:

Upholstery colours:*

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Standard Equipment

  • Frame with castors and brakes
  • Separate adjustable foot rest with footers and feet stabilizing belts
  • Seat
  • Seat cushion
  • Abduction block adjustable
  • Backrest
  • Backrest cushion
  • Pelvic belt
  • Chest supports
  • Vest
  • Adjustable headrest
  • Elbow support
  • Tray

Accessories:

Safety:
Positioning:
BodyMap® POSITIONING:
Comfort:
Storage:
Spare parts:
Message to us:
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