Order form – Dalmatian Invento 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 1 / Grasssize 2 / Seasize 3 / SeaStandard EquipmentFrame with castors and brakesGas springDeep adjustable seatRemovable and adjustable abduction blockKnee supportBackrestPelvic belt ('hold & pull' system)Chest support (size 1, 2)Independently adjustable chest and pelvic support (size 3)4 points safety vest ('Hold & Pull' system) (1)Adjustable HexagonPro™ headrestForearm supportsTrayIndependently adjustable footrestInnovative quadric mechanismBreathable upholstery ATMOTM – size 1 GRASS, size 2 SEA, size 3 SEAAccessories:Safety:DMI_015 TANGO Wheel (75 mm) (A)DMI_015 TANGO Wheel (75 mm) (I)DMI_016 TANGO Wheel (125 mm) (A)DMI_016 TANGO Wheel (125 mm) (I)DMI_020 TANGO Wheel (100 mm) (A)DMI_020 TANGO Wheel (100 mm) (I)Positioning:DMI_101 Thigh abduction belts (size 0)DMI_101 Thigh abduction belts ( size 1)DMI_101 Thigh abduction belts (size 2)DMI_101 Thigh abduction belts (size 3)DMI_102 Head supporting belt for HexagonProTM HeadrestDMI_102 Head supporting belt for VisoProTM HeadrestDMI_103 3D foot adjustment (U)DMI_103 3D foot adjustment (I)DMI_106 Lower limbs supporting cushionsDMI_109 Independently adjustable side supports (size 1) (I)DMI_109 Independently adjustable side supports (size 2) (I)DMI_114 H Harness (I) (1)DMI_114 H Harness (A) (1)DMI_123 Adjustable extended headrest (I)DMI_125 6 points safety vest S (I) (1)DMI_125 6 points safety vest S (A) (1)DMI_125 6 points safety vest M (I) (1)DMI_125 6 points safety vest M (A) (1)DMI_125 6 points safety vest L (I) (1)DMI_125 6 points safety vest L (A) (1)DMI_125 6 points safety vest XL (I) (1)DMI_125 6 points safety vest XL (A) (1)DMI_126 Trunk beltDMI_161/1 Foot and ankle stabilizing sandals(EUR: 21 – 24, CM: 13 – 15 cm; UK: 4,5 – 7, IN: 5,1 – 5,9 in)DMI_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)DMI_161/3 Foot and ankle stabilizing sandals(EUR: 27 – 31, CM: 17 – 19,5 cm; UK: 9 – 12, IN: 6,7 – 7,7 in)DMI_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)DMI_162/1 Dynamic ankle stabilizers (FP-22) (size XS, perimeter of the ankle CM: 4 – 17 cm; IN: 6 – 7 in)DMI_162/2 Dynamic ankle stabilizers (FP-22) (size S, perimeter of the ankle CM: 16,5 – 20 cm; IN: 6 – 8 in)DMI_162/3 Dynamic ankle stabilizers (FP-22) (size M, perimeter of the ankle CM: 19 cm – 23,5 cm; IN: 7 – 9 in)DMI_162/4 Dynamic ankle stabilizers (FP-22) (size L, perimeter of the ankle CM: 23 cm – 28 cm; IN: 9 – 11 in)DMI_162/5 Dynamic ankle stabilizers (FP-22) (size XL, perimeter of the ankle CM: 26,5 cm – 33 cm; IN: 10 – 13 in)DMI_168 VisoProTM HeadrestComfort:DMI_431/1 Push handle, height - 1 cm from the backrest DMI_431/2 Push handle, height - 19 cm from the backrest DMI_431/3 Push handle, height - 31 cm from the backrest *DMI_453 PA-VM-15 Cushion (Seat cushion with bolster)Storage:DMI_507 Oxygen tank holder * 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) H HARNESS, 4 POINTS AND 6 POINTS SAFETY VESTS SHOULD BE USED WITH ABDUCTION BLOCK OR THIGH ABDUCTION BELTS _101.(U) THE MAXIMUM HEIGHT OF THE USER SHOULD BE REDUCED BY 6 CM. SEE SIZE TABLE.Message to us:SubmitReset