Order form – Jordi

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:*

Standard Equipment

  • Backrest tilt angle
  • Tilt In Space adjustment
  • Adjustable depth of the seat
  • Medical Upholstery
  • Pelvic belt
  • Adjustable armrests

Accessories:

Safety:
Comfort:
Build-up:
Spare parts:
Message to us: