Order Form – URSUS HOME 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 2size 3Choose upholstery:Waterproof Upholstery HYDRO™ colour:*Light GrayReversible Cotton-Washable Pad COMFORT colours:Rose*RubyOceanSpaceLavaLilacStandard equipmentAdjustable headrestAnatomical lateral supports5 points safety belts with height adjustmentHeight adjustable backrestAngle adjustable backrestDepth and width adjustable seatSeat unit with ClickClackTM system for easy click in/outFully reclining backrest converting the stroller into a lounger (couch function)Pneumatic tilt-in space system TILT-IQ™Height and angle adjustable footrest5 points feet stabilizing belts with heel support and foot abduction-adduction adjustmentsSoft upholstery with spine load reducing and ventilating functionSoft front bar with reflective safety marksHi-low frame equipped with castors with brakes and push handlesGas springWaterproof upholstery HYDRO™ / Reversible cotton-washable pad COMFOR™ (ROSE, SPACE, LAVA, RUBY*,OCEAN, LILAC).*Available until the stocks lastAccessories:Safety:USH_001 LED lightsPositioning:USH_107 Pelvic brace with pelvic beltUSH_114 H Harness (I) (4)USH_114 H Harness (A) (4)USH_125 6 points safety vest S (I) (4)USH_125 6 points safety vest S (A) (4)USH_125 6 points safety vest M (I) (4)USH_125 6 points safety vest M (A) (4)USH_125 6 points safety vest L (I) (4)USH_125 6 points safety vest L (A) (4)USH_125 6 points safety vest XL (I) (4)USH_125 6 points safety vest XL (A) (4)USH_127 Chest supportUSH_128 Abduction block (1)USH_130 4 points safety vest (I) (4)USH_130 4 points safety vest (A) (4)USH_161/1 Foot and ankle stabilizing sandals(EUR: 21 – 24, CM: 13 – 15 cm; UK: 4,5 – 7, IN: 5,1 – 5,9 in)USH_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)USH_161/3 Foot and ankle stabilizing sandals(EUR: 27 – 31, CM: 17 – 19,5 cm; UK: 9 – 12, IN: 6,7 – 7,7 in)USH_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)USH_163 Anatomic thigh abduction belts (FP-23)USH_163/1 Anatomic thigh abduction belts (FP-23) (size M)USH_163/2 Anatomic thigh abduction belts (FP-23) (size L)Comfort:USH_403 Tray (black color) (2)USH_403 Tray (light grey color) (2)USH_411 Cup holderUSH_449 Reversible cotton-washable pad COMFORT™ ROSE (A)USH_449 Reversible cotton-washable pad COMFORT™ SPACE (A)USH_449 Reversible cotton-washable pad COMFORT™ LAVA (A)USH_449 Reversible cotton-washable pad COMFORT™ RUBY (W) (A)USH_449 Reversible cotton-washable pad COMFORT™ OCEAN (A)USH_449 Reversible cotton-washable pad COMFORT™ LILAC (A)USH_452 Phone holder*USH_453 PA-VM-15 Cushion ( Seat cushion with bolster)Storage:USH_507 Oxygen tank holder USH_509 Organizer bagUSH_511 VOYAGER backpackUSH_512 FLASH backpackBuild-upUSH_608 Outdoor Frame URSUSUSH_615 URSUS seatSpare parts:USH_704 All Terrain wheel (I)USH_704 All Terrain wheel (A)* 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) 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) CAN BE ASSEMBLED ONLY IF THE SEAT IS FACING FRONT.(3) 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.(4) H HARNESS, 4 POINTS AND 6 POINTS SAFETY VESTS SHOULD BE USED WITH _101, _128 OR _163.(W) AVAILABLE UNTIL THE STOCKS LASTMessage to us:SubmitReset