Order Form – Nova Evo® Order numer: 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 CityVenezuelaVietnamYemenZambiaZimbabweCountryPhone:(1) Area Code - Phone Number Ship product:*AssembledDissasembledProduct size:*size 1 Turquoise/AQUAsize 2 Black/ MELANGEsize 3 Black/ CADETStandard EquipmentFoldable frameRemovable rear inflatable wheelsFront swivel PU wheelsAdjustable rear wheelbase Smart TractionAdjustable footrest with 2-point feet stabilizing beltsSeat cushionPush handle5-point safety beltsAdjustable headrestSafety railCentral brake (hand brake can be ordered - _439, at an additional cost)Flex upholsteryTilt-in-space adjustmentWaterproof upholstery HYDRO™ size 1 AQUA, size 2 MELANGE, size 3 CADETAccessories:Safety:NVE_001 LED lightsNVE_002 Belt for moving patients AM-P ) (size 3)Safety:(1)NVE_101 Thigh abduction belts (size 0)NVE_101 Thigh abduction belts (size 1)NVE_101 Thigh abduction belts (size 2)NVE_101 Thigh abduction belts (size 3)NVE_107 Pelvic beltNVE_114 H Harness (I) (1)NVE_114 H Harness (A) (1)NVE_126 Trunk beltNVE_128 Abduction blockNVE_130 4 points safety vest (I) (1)NVE_130 4 points safety vest (A) (1)NVE_134 Narrowing pads 6 cmNVE_137 Narrowing pads 10 cmNVE_147 5 points feet stabilizing belts (I)NVE_160/1 Shaped OCTAGON™ headrest with the head support - size 1NVE_160/2 Shaped OCTAGON™ headrest with the head support - size 2NVE_160/3 Shaped OCTAGON™ headrest with the head support - size 3NVE_161/1 Foot and ankle stabilizing sandals(EUR: 21 – 24, CM: 13 – 15 cm; UK: 4,5 – 7, IN: 5,1 – 5,9 in)NVE_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)NVE_161/3 Foot and ankle stabilizing sandals(EUR: 27 – 31, CM: 17 – 19,5 cm; UK: 9 – 12, IN: 6,7 – 7,7 in)NVE_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)NVE_162/1 Dynamic ankle stabilizers (FP-22)(size XS, perimeter of the ankle CM: 4 – 17 cm; IN: 6-7 in)NVE_162/2 Dynamic ankle stabilizers (FP-22)(size S, perimeter of the ankle CM: 16.5 – 20 cm; IN: 6-8 in)NVE_162/3 Dynamic ankle stabilizers (FP-22)(size M, perimeter of the ankle CM: 19 cm – 23.5 cm; IN: 7-9 in)NVE_162/4 Dynamic ankle stabilizers (FP-22)(size L, perimeter of the ankle CM: 23 cm – 28 cm; IN: 9-11 in)NVE_162/5 Dynamic ankle stabilizers (FP-22) (size XL, perimeter of the ankle CM: 26.5 cm – 33 cm; IN: 10-13 in)NVE_163/1 Anatomic thigh abduction belts (FP-23) (size M)NVE_163/2 Anatomic thigh abduction belts (FP-23) (size L)*NVE_170/1 Pelvis stabilizer (FP-16) (size S, pelvic width 19 - 25 cm, depth 18 cm, height 20 cm) (size 1)*NVE_170/2 Pelvis stabilizer (FP-16) (size M, pelvic width 25 - 31 cm, depth 21 cm, height 23 cm) (size 1, 2)*NVE_170/3 Pelvis stabilizer (FP-16) (size L, pelvic width 31 - 38 cm, depth 24 cm, height 25 cm) (size 2, 3)*NVE_170/4 Pelvis stabilizer (FP-16) (size XL, pelvic width 38 - 45 cm, depth 30 cm, height 27 cm) (size 3)Comfort:NVE_403 Tray (black color)NVE_403 Tray (light grey color)NVE_405 Foding canopyNVE_408 Rain cover (2)NVE_409 Mosquito net (2)NVE_411 Cup holderNVE_412 Elastico seat cushionNVE_415 Wheel coversNVE_417 Winter footmuff with muffsNVE_439 Hand brake (3)NVE_445 FootmuffNVE_447 Winter muffsNVE_452 Phone holder**NVE_453 PA-VM-15 Cushion (Seat cushion with bolster)Storage:NVE_501 BagNVE_506 Carrier bag for folded stroller with pockets for wheelsNVE_509 Organizer bagNVE_511 VOYAGER backpackNVE_512 FLASH backpackBuild-up:NVE_625 HOME moduleNVE_627 NOVA moduleNVE_630 Bicycle tow bar with a flag (size 1,2)NVE_635 Tow bar linkage (size 1, 2)Spare parts:NVE_704 All Terrain wheels (I) (4)NVE_704 All Terrain wheels (A) (4)* 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 ELEMENTS _101, _128 OR _163.(2) TO MOUNT THE RAIN COVER ON THE STROLLER, IT IS NECESSARY TO MOUNT THE FOLDING CANOPY FIRST. THE FOLDING CANOPY IS NOT A STANDARD EQUIPMENT.(3) DUE TO THE IMPOSSIBILITY OF SELF-ASSEMBLY OF THE COMPONENT, THE ORDER OF THE HAND BRAKE (_439) SHOULD BE MADE AT THE ORDER STAGE. LEAD TIME ca. 30 DAYS.(4) LEAD TIME ca. 30 DAYS.Message to us:SubmitReset
