Order form – PARAMOBIL™ 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 0Size 1Size 2Size 3Product Module:*STATIC - DYNAMIC - REHABILITATION MODULESTATIC REHABILITATION - MODULEDYNAMIC - REHABILITATION MODULEREHABILITATION MODULESTATIC - DYNAMIC MODULESTATIC MODULEDYNAMIC MODULEStandard EquipmentSTATIC - DYNAMIC - REHABILITATION MODULE:Frame with castors and brakesFoot stabilizationKnee stabilization with adjustable knee supportsChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Forearm supports with gripsTraySeparator of lower limbsElectric-mechanic rotorSTATIC REHABILITATION - MODULE:Frame with castors and brakesFoot stabilizationKnee stabilization with adjustable knee supportsChest brace with chest support (adjustable)Forearm supports with gripsTrayElectric-mechanic rotorWide or narrow seatDYNAMIC - REHABILITATION MODULEFrame with castors and brakesChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Forearm supports with gripsElectric-mechanic rotorWide or narrow seatREHABILITATION MODULE:Frame with castors and brakesChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Forearm supports with gripsWide or narrow seatSTATIC - DYNAMIC MODULE:Frame with castors and brakesChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Separator of lower limbsTrayFoot stabilizationKnee stabilization with adjustable knee supportsWide or narrow seatSTATIC MODULE:Frame with castors and brakesChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Forearm supports with gripsFoot stabilizationKnee stabilization with knee adjustable supportsDYNAMIC MODULE:Frame with castors and brakesChest brace with chest support (adjustable)Pelvic brace with pelvic support (adjustable)Forearm supports with gripsAccessories:Safety:PML_002 Belt for moving patients AM-P (size 3)PML_008 Steel wheel with brake (75 mm) (I)PML_009 Castor with friction brake (75 mm) (I)PML_009 Castor with friction brake (75 mm) (A)PML_010 Castor with blockade of reverse movement (75 mm) (I)PML_010 Castor with blockade of reverse movement (75mm) (A)PML_011 Castor with fixed direction of movement (75 mm) (I)PML_011 Castor with fixed direction of movement (75 mm) (A)PML_015 TANGO Wheel with brake (75 mm) (I)PML_015 TANGO Wheel with brake (75 mm) (A)PML_016 TANGO Wheel with brake (125 mm) (I)PML_016 TANGO Wheel with brake (125 mm) (A)PML_018 TANGO Wheel with fixed direction of movement (125 mm) (I)PML_018 TANGO Wheel with fixed direction of movement (125 mm) (A)PML_019 Steel wheel with brake (125 mm) (I)PML_020 TANGO Wheel with brake (100 mm) (I)PML_020 TANGO Wheel with brake (100 mm) (A)PML_023 TANGO Wheel with fixed direction of movement (75 mm) (I)PML_023 TANGO Wheel with fixed direction of movement (75 mm) (A)Positioning:PML_111 Independently adjustable knee supports (I)PML_118 Hip supporting harnessPML_120 Pelvic harnessPML_122 Pelvic cushion (different widths)*PML_140 High armpit supportsComfort:PML_403 Tray (2)(1) _141 USED WITH LOWER LIMBS BRACES.(2) FOR DYNAMIC OR REHABILITATION MODULE WHEN ORDERED WITHOUT THE STATIC.Message to us:SubmitReset
