Order form – ULISES EVO™ 2022 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 1size 1asize 2size 2asize 3Choose upholstery:Upholstery colours:*Space Gray*NeptuneStandard equipmentFlex upholstery5 points safety beltsAdjustable footrest with 4 points feet stabilizing beltsWheels with glass fiber, front PU swivel, rear with central brake with adjustable down forceAngle adjustable backrestAdjustable push handlesBodyPrint™ seat belt system adjusting the tension of the seat upholstery and backrestAdjustable height and tilt angle of the footrestAdjustable depth of the seatBackrest extensionHeadrestHYDRO™ upholstery with stabilizing side supports – size 1 - 3 SPACE GRAY or NEPTUNE****** LEAD TIME FOR UPHOLSTERY NEPTUNE - UP TO 30 DAYSAccessories:Safety:ULE_001 LED lights ULE_002 Belt for moving the patients AM-P (size 3)ULE_013 Safety rail Positioning:ULE_101 Thigh abduction belts (size 0)ULE_101 Thigh abduction belts (size 1)ULE_101 Thigh abduction belts (size 2)ULE_101 Thigh abduction belts (size 3)ULE_107 Pelvic brace with pelvic beltULE_113 Trunk stabilizing belt (size 1, 1a, 2)ULE_114 H Harness (I) (7)ULE_114 H Harness (A) (7)ULE_124 Loins supportULE_125 6 points safety vest S (I) (7)ULE_125 6 points safety vest S (A) (7)ULE_125 6 points safety vest M (I) (7)ULE_125 6 points safety vest M (A) (7)ULE_125 6 points safety vest L (I) (7)ULE_125 6 points safety vest L (A) (7)ULE_125 6 points safety vest XL (I) (7)ULE_125 6 points safety vest XL (A) (7)ULE_126 Trunk beltULE_128 Adjustable abduction block (1)ULE_130 4 points safety vest (I) (7)ULE_130 4 points safety vest (A) (7)ULE_147 5 points feet stabilizing belts (I)ULE_155/1 Chest support - narrow, short (2)ULE_155/2 Chest support - narrow, long (2)ULE_155/3 Chest support - wide (2)ULE_160/1 Shaped OCTAGON™ headrest with the head support – size 1 (3)ULE_160/2 Shaped OCTAGON™ headrest with the head support – size 2 (3)ULE_160/3 Shaped OCTAGON™ headrest with the head support – size 3 (3)ULE_161/1 Foot and ankle stabilizing sandals(EUR: 21 – 24, CM: 13 – 15 cm; UK: 4,5 – 7, IN: 5,1 – 5,9 in)ULE_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)ULE_161/3 Foot and ankle stabilizing sandals(EUR: 27 – 31, CM: 17 – 19,5 cm; UK: 9 – 12, IN: 6,7 – 7,7 in)ULE_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)ULE_162/1 Dynamic ankle stabilizers (FP-22)(size XS, perimeter of the ankle CM: 4 – 17 cm; IN: 6-7 in)ULE_162/2 Dynamic ankle stabilizers (FP-22)(size S, perimeter of the ankle CM: 16.5 – 20 cm; IN: 6-8 in)ULE_162/3 Dynamic ankle stabilizers (FP-22)(size M, perimeter of the ankle CM: 19 cm – 23.5 cm; IN: 7-9 in)ULE_162/4 Dynamic ankle stabilizers (FP-22)(size L, perimeter of the ankle CM: 23 cm – 28 cm; IN: 9-11 in)ULE_162/5 Dynamic ankle stabilizers (FP-22)(size XL, perimeter of the ankle CM: 26.5 cm – 33 cm; IN: 10-13 in)ULE_163/1 Anatomic thigh abduction belts (FP-23) (size M)ULE_163/2 Anatomic thigh abduction belts (FP-23) (size L)*ULE_170/1 Pelvis stabilizer (FP-16) (size S, pelvic width 19 - 25 cm, depth 18 cm, height 20 cm) (size 1, 1a)*ULE_170/2 Pelvis stabilizer (FP-16) (size M, pelvic width 25 - 31 cm, depth 21 cm, height 23 cm) (size 1, 1a, 2, 2a)*ULE_170/3 Pelvis stabilizer (FP-16) (size L, pelvic width 31 - 38 cm, depth 24 cm, height 25 cm) (size 2, 2a, 3)*ULE_170/4 Pelvis stabilizer (FP-16) (size XL, pelvic width 38 - 45 cm, depth 30 cm, height 27 cm) (size 3)Comfort:ULE_402 UmbrellaULE_403 Tray (black color) ULE_405 Folding canopyULE_408 Rain cover (4)ULE_411 Cup holderULE_415 Rear wheel coversULE_417 Winter footmuff with muffsULE_429 Soft footrest coverULE_433 Lifting barULE_437 Extended footrest (size 1 – 6 cm; size 1a, 2 – 8 cm; size 2a, 3 – 10 cm) with front swivel wheels brake (I) (5)ULE_437 Extended footrest (size 1 – 6 cm; size 1a, 2 – 8 cm; size 2a, 3 – 10 cm) with front swivel wheels brake (A) (5)ULE_439 Handbrake (6)ULE_440 Front wheel locks (I)ULE_440 Front wheel locks (A)ULE_442 Front wheel coversULE_444 ArmrestULE_447 Winter muffsULE_452 Phone holder**ULE_453 PA-VM-15 Cushion (Seat cushion with bolster)Storage:ULE_501 BagULE_505 Under seat storage basketULE_506 Carrier bag for the strollerULE_507 Oxygen tank holder ULE_509 Organizer bagULE_511 VOYAGER backpackULE_512 FLASH backpackSpare parts:ULE_704 All Terrain wheel (I)ULE_704 All Terrain wheel (A)* 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) 5 POINTS SAFETY BELTS ARE NOT AVAILABLE WITH _128. PLEASE CHOOSE _114 OR _130 INSTEAD, FREE OF CHARGE. PLEASE CHOOSE _125 INSTEAD, ADDITIONAL CHARGE 30 EUR.(2)NOT ALL VERSIONS OF THE STROLLER ARE COMPATIBLE WITH ULE_155. CONTACT THE SALES DEPARTMENT(3) OVERALL WIDTH OF THE HEADREST IN SIZE 1 – 23 CM, SIZE 2 – 26 CM, SIZE 3 – 30 CM.(4) 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.(5) THE EXTENDED FOOTREST COLLIDES WITH THE FRONT SWIVEL WHEELS WHEN THE WHEELS ARE NOT BLOCKED.(6) THERE IS AN OPTION TO PURCHASE THE STROLLER WITH BRAKE LEVER (MARK ELEMENT _439). THERE IS NO POSSIBILITY TO ASSEMBLE BRAKE LEVER SINGLE-HANDEDLY LATER. LEAD TIME CA. 30 DAYS.(7) H HARNESS, 4 POINTS AND 6 POINTS SAFETY VESTS SHOULD BE USED WITH _101, _128 OR _163.Message to us:SubmitReset
