Order form – HARMONY™ 14.12.2023 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*size 1Upholstery colour:*MELANGEVULCANOCOBALT*FLAMING*THE LEAD TIME FOR SELECTED COLORS (FLAMING) MAY BE LONGER.Standard EquipmentFoldable frameHead stabilizersAdjustable chest supports5 points safety belts with padSafety railRemovable abduction blockAdjustable pelvic supportsDetachable and reversible seat unitTilt-in-space adjustmentAdjustable footrest with supporting beltArmrestsFolding canopyAdjustable push handleUnder seat storage basketBagRain coverFront PU swivel wheels with direction blockade – quick releaseRear PU wheels with central brake – quick releaseHard/soft suspension system (City/Comfort)Waterproof upholstery HYDRO™ : COBALT / VULCANO / MELANGE / FLAMING (1)Accessories:Safety:HRY_001 LED lightsPositioning:HRY_101 Thigh abduction belts (size 0)HRY_101 Thigh abduction belts (size 1)HRY_101 Thigh abduction belts (size 2)HRY_101 Thigh abduction belts (size 3)HRY_114 H Harness (I)HRY_114 H Harness (A)HRY_130 4 points safety vest (I)HRY_130 4 points safety vest (A)HRY_161/1 Foot and ankle stabilizing sandals (EUR: 21 – 24, CM: 13 – 15 cm; UK: 4,5 – 7, IN: 5,1 – 5,9 in)HRY_161/2 Foot and ankle stabilizing sandals (EUR: 25 – 27, CM: 15 – 17 cm; UK: 7,5 – 9,5, IN: 5,9 – 6,7 in)HRY_161/3 Foot and ankle stabilizing sandals (EUR: 27 – 31, CM: 17 – 19,5 cm; UK: 9 – 12, IN: 6,7 – 7,7 in)HRY_161/4 Foot and ankle stabilizing sandals (EUR: 31 – 35, CM: 19,5 – 22,4 cm; UK: 12 – 2,5, IN: 6,7 – 8,8 in)HRY_162/1 Dynamic ankle stabilizers (FP-22) (size XS, perimeter of the ankle CM: 4 – 17 cm; IN: 6 – 7 in)HRY_162/2 Dynamic ankle stabilizers (FP-22) (size S, perimeter of the ankle CM: 16,5 – 20 cm; IN: 6 – 8 in)HRY_162/3 Dynamic ankle stabilizers (FP-22) (size M, perimeter of the ankle CM: 19 cm – 23,5 cm; IN: 7 – 9 in)HRY_162/4 Dynamic ankle stabilizers (FP-22) (size L, perimeter of the ankle CM: 23 cm – 28 cm; IN: 9 – 11 in)HRY_162/5 Dynamic ankle stabilizers (FP-22) (size XL, perimeter of the ankle CM: 26,5 cm – 33 cm; IN: 10 – 13 in)Comfort:HRY_403 Tray (black color)HRY_409 Mosquito netHRY_411 Cup holderHRY_415 Rear wheel coversHRY_442 Front wheel coversHRY_445 FootmuffHRY_447 Winter muffsHRY_452 Phone holder*HRY_453 PA-VM-15 Cushion ( Seat cushion with bolster)Storage:HRY_509 Organizer bagHRY_511 VOYAGER backpackHRY_512 FLASH backpackAdditional upholstery:HRY_700 Waterproof upholstery HYDROTM FLAMING (1)HRY_700 Waterproof upholstery HYDROTM COBALT HRY_700 Waterproof upholstery HYDROTM VULCANO HRY_700 Waterproof upholstery HYDROTM MELANGE* IT IS NOT POSSIBLE TO USE THE ADJUSTABLE ABDUCTION BLOCK WHILE USING THE SEAT CUSHION WITH BOLSTER. ** CUSTOM-MADE. LEAD TIME ca. 30 DAYS. (1) THE LEAD TIME FOR SELECTED COLORS (FLAMING) MAY BE LONGER.Message to us:SubmitReset
