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Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 1 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tx / Price are valid starting 12.02.2018 / Technical changes and misprints reserved. PU=packing unit
last change on 8. Februar 2019, 9:09 vorm.
address/ company stamp:
your pseudonymized reference: ______________________________________
date: signature:
an offerto order
Orders of spare parts receive a spare parts discount (only exception are the positions of the side truss pads where the customized product discount applies). For orders/enquiries to current new wheelchair orders/enquiries, the agreed wheelchair discount applies. Without reference to an ongoing wheelchair order, the spare parts discount applies.
spare partsequipment for a new wheelchair (-order/-enquiry) from _______________
Please fill out this page completely.On the next page, please write the amount of the product requested in the appropriate area.
The order / enquiry is to be sent WITH this page with the number of sent pages (including this page)
by e-mail to [email protected] or by fax to 0049-7254-9279-10
Please only send pages, that list your chosen products.
I would like...
This order/enquiry has, including this page
pages.
reviser:
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
Seite 2 von 7
letzte Änderung am 8. Februar 2019, 9:09 vorm.
780502017805020278050203780502047805020578050206
780504017805040278050403780504047805040578050406
780106780107780108
78050210
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 2 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
Please write the amount of the product requested in the appropriate area, then chose the belt connection accordingly (lower and/or upper belt adapter, with choice of pipe clamps / buckles) on the pages to follow.
2-point-pelvic belt
product nr. product description PU price/PU amount2-point-pelvic belt size 1 with plastic fastener piece2-point-pelvic belt size 2 with plastic fastener piece2-point-pelvic belt size 3 with plastic fastener piece2-point-pelvic belt size 1 with metal fastener piece2-point-pelvic belt size 2 with metal fastener piece2-point-pelvic belt size 3 with metal fastener piece
size A B C D1 148 14 5 2,52 156 17 6 2,53 166 22 7 2,5
measurements in cm
4-point-pelvic belt
product nr. product description PU price/PU amount4-point pelvic belt size 1 with plastic fastener piece4-point pelvic belt size 2 with plastic fastener piece4-point pelvic belt size 3 with plastic fastener piece4-point pelvic belt size 1 with metal fastener piece4-point pelvic belt size 2 with metal fastener piece4-point pelvic belt size 3 with metal fastener piece
size A B C D E1 148 14 5 2,5 2,52 156 17 6 2,5 2,53 166 22 7 4 2,5
measurements in cm
Fasteningmaterial for belts(to mount on frame)
product nr. product description PU price/PU amountpipe clamps-set (2 clamps) setplastic buckles size 1 (25mm) 4 pc. setplastic buckles size 2 (40mm) 4 pc. set
Easily slide the protection cap over the metal fastener and the lock can only be opened
with a pin or the like.
protection cap for metal fastener product nr. product description PU price/PU amount
protection cap for metal fastener piece
application example
129,- €129,- €129,- €149,- €149,- €149,- €
159,- €159,- €159,- €189,- €189,- €189,- €
10,- €14,- €17,- €
14,- €
781000781001781002
781003781004
781201781202781203
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 3 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
Chest-shoulder belt
product nr. product description PU price/PU amountchest-shoulder belt size 0 without zipper piecechest-shoulder belt size 1 without zipper piecechest-shoulder belt size 2 without zipper piece
chest-shoulder belt size 3 without zipper piecechest-shoulder belt size 4 without zipper piece
size A B C D E0 8 17 22 8 111 9 21 27 10 122 12 24 36 14 143 17 30 42 15 184 20 32 48 17 21
measurements in cm
Foot fixation
product nr. product description PU price/PU amountfoot fixation with Velcro/fleece fastener and guide roller size 1 pairfoot fixation with Velcro/fleece fastener and guide roller size 2 pairfoot fixation with Velcro/fleece fastener and guide roller size 4 pair
size length L1 15-20 cm2 19-23 cm4 24-28 cm
L
189,- €189,- €189,- €
189,- €189,- €
189,- €189,- €189,- €
780101780102780103780104780105
780120
780121
650054
780110
68600804
64..
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 4 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
Upper belt holder for models Mio, Vector, Kika, Jump alpha, Jump beta, Tilty Vario, Tilty II, Loop RS and Mio MoveTo fasten chest-shoulder belts
For a successful adaptation of the upper belt holder the following products must be on your wheelchair. Missing products can be easily ordered here.
• For available head rest with square tube
product nr. product description PU price/PU amount
Square tube with 15x15mm adapter, completely blackfor upper belt connection incl. mounting material
piece
Square tube with 10x10mm adapter, completely blackfor upper belt connection at Lightweight head
piece
• For available head rest with section tube
product nr. product description PU price/PU amount
Push handle/head rest holder 38mm straight,for mounting on stabilizing rod.incl. mounting material
piece
• Without available head restproduct nr. product description PU price/PU amount
Holding rod for upper belt holder, 300mm length piece
Push handle/head rest holder 38mm straight, for mounting on stabilizing rod. incl. mounting material
piece
Stabilizing rod (if not available)The push handle/head rest holder (650054) can be mounted on any SORG-stabilizing rod.
For the order of a stabilizing rod, we need the information of…
…the serial nr.
…the seat width
piece
measurement X
mounting e.g.„upper belt holder“.
Image similar.
product product description M. X PU price/PUupper belt holder (recommended for sw 20-22) 140 mm pieceupper belt holder (recommended for sw 24-30) 200 mm pieceupper belt holder (recommended for sw 32-36) 260 mm pieceupper belt holder (recommended for sw 38-42) 320 mm pieceupper belt holder (recommended for sw 44-46) 380 mm piece
56,- € 56,- € 56,- € 56,- € 56,- €
34,- €
34,- €
34,- € 34,- €
30,- €
34,- €
105,- €
At new wheelchair orders the price is 90,-€ (Upper belt holder + 780120 or 650054)
780202780203780204780205
780301780302
780201780202780203
780201780202780203780204
780401780402780403
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 5 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
product nr. product description M. X PU price/PU amountlower belt adapter (for SW 26-30) 260 mm piecelower belt adapter (for SW 32-36) 320 mm piecelower belt adapter (for SW 38-42) 380 mm piecelower belt adapter (for SW 44-48) 440 mm piece
Lower belt holder for Vector/Mio/Tilty Vario/Loop RSFor the attachment of 2-point/4-point and/or chest-shoulder belts.
measurement X
product nr. product description M. X PU price/PU amountlower belt adapter (recommended for SW 20-24) 210 mm piecelower belt adapter (recommended for SW 26-30) 270 mm piece
Lower belt adapter for model KikaFor the attachment of 2-point/4-point and/or chest-shoulder belts.
measurement X
*attachment on firm seat plate (not possible with a seat cover)Vector*
product nr. product description M. X PU price/PU amountlower belt adapter (for SW 18-22) 200 mm piecelower belt adapter (for SW 24-28) 260 mm piecelower belt adapter (for SW 30-34) 320 mm piece
Mio
product nr. product description M. X PU price/PU amountlower belt adapter (for SW 28-30) 200 mm piecelower belt adapter (for SW 32-36) 260 mm piecelower belt adapter (for SW 38-42) 320 mm piecelower belt adapter (for SW 44-48) 360 mm piece
Tilty Vario / Loop RS
Kika
product nr. product description M. X PU price/PU amountlower belt adapter (recommended for SW 20-24) 190 mm piecelower belt adapter (recommended for SW 26-30) 250 mm piecelower belt adapter (recommended for SW SB 32-36) 310 mm piece
Lower belt adapter for Mio MoveFor the attachment of 2-point/4-point and/or chest-shoulder belts.
measurement XMio Move
mounting e.g.„lower belt holder“.
Image similar.
mounting e.g.„lower belt holder“.
Image similar.
mounting e.g.„lower belt holder“.
Image similar.
56,- €56,- €56,- €56,- €
56,- €56,- €
56,- €56,- €56,- €
56,- €56,- €56,- €56,- €
56,- €56,- € 56,- €
6859010168590102685901036859010468590105
6859020168590202685902036859020468590205
6859011068590111
1952195319541951
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 6 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
Image:truss pad holder size 2
Side truss pads
product nr. product description PU price/PU amountsize 1adjustable holder size 1 for left side (without cushion) up to max. 35kg pieceadjustable holder size1 for right side (without cushion) up to max. 35kg pieceadditional extention joint (4,3 cm) for holder size 1 piececushion incl. removable cover for holder size 1 (10 x 7 cm) piececushion incl. removable cover for holder size 1 (10 x 9 cm) piece
size 2adjustable holder size 2 for left side (without cushion) from BH35 pieceadjustable holder size 2 for right side (without cushion) from BH35 pieceadditional extention joint (5,5cm) for holder size 2 piececushion incl. removable cover for holder size 2 (15 x 10) piececushion incl. removable cover for holder size 2 (18 x 13) piece
holder set to connect the side truss pads to the back
holder set for Mio / Kika pieceholder set for Vector / Jump alpha / Jump beta / Tilty Vario / Mio Move piece
Image:truss pad holder size 1
Abduction wedge
product nr. product description PU price/PU amountabduction wedge size S 94x65x90 mm (L x W x H) incl. holder a. cushion piece
abduction wedge size M 110x82x95 mm (L x W x H) incl. holder a. cushion piece
abduction wedge size L 125x90x100 mm (L x W x H) incl. holder a. cushion piece
holder for abduction wedge (without cushion) piece
Image: mounting sizes S, M and L
Not with a seat cover
Image:truss pad cushion 18x13 cm / 15x10 cm / 10x9 cm / 10x7 cm
For all positions of the side truss pads only the CUSTOMIZED PRODUCT DISCOUNT applies.
188,- €188,- €60,- €50,- €50,- €
188,- €188,- €60,- €50,- €50,- €
40,- €40,- €
198,- € 198,- €198,- €143,- €
686009206860092168602168602268602368602468602568602668600804
6400
Order form positioning aids2-point-pelvic belt / 4-point-pelvic belt / chest-shoulder belt / foot fixations / belt holder / belt adapter / abduction wedges / side truss pads / headrests
Please send order/enquiry by fax to +49 7254-9279-10or by e-mail to [email protected]
SORG Rollstuhltechnik GmbH + Co.KGBenzstr. 3-5, 68794 Oberhausen-Rheinhausen
page 7 of 7
Orders of spare parts receive a spare parts discount. For an order of a new w
heelchair at the same tim
e, the agreed wheelchair discount applies. W
ithout reference to an ongoing w
heelchair order, the spare parts discount applies. All prices plus tax / Price are valid starting 01.01.2019 / Technical changes and misprints reserved.
last change on 8. Februar 2019, 9:09 vorm.
address / company stamp:
commission: reviser:date: signature:
offerorder
Orders of spare parts receive a spare parts discount. For an order of a new wheelchair at the same time, the agreed wheelchair discount applies. / PU=packing unit
spare part to new wheelchair from:
Lightweight head rest for weight reductionDesign Lightweight head rest for Mio, Mio Carbon and Mio Move
curvedlightweight
Standard head rest Design Standard head rest model 1 Standard head rest model 2
shell shaped
Design Standard head rest model 3 Standard head rest model 4
curvedstandard
Design Standard head rest model 5 Standard head rest model 6
X-shaped
width (x)
heig
ht (y
)
depth 30
Head rests
product nr. product description PU price/PU amountlight weight head size 1 rest for Mio, Mio Carbon and Mio Move (incl. height adjustable holder) piece
light weight head size 2 rest for Mio, Mio Carbon and Mio Move (incl. height adjustable holder) piece
head rest model 1, shell-shaped small (incl. height adjustable holder) piece
head rest model 2, shell-shaped large (incl. height adjustable holder) piece
head rest model 3, curved small (incl. height adjustable holder) piece
head rest model 4, curved large (incl. height adjustable holder) piece
head rest model 5, X-shaped small (incl. height adjustable holder) piece
head rest model 6, X-shaped large (incl. height adjustable holder) piece
rod holder head rest on stabilizing rod (square 15x15mm)
Please chose (if not available) a stabilizing rod by indicating the serial number and seat width of the wheel-chair
stabilizing rod (size depends on serial number + seat width) piece
serial number:
seat width:
measurements in mm, all measures ± 10mm
Lightweight head rest, adjustable with two conical joints, connection and re-movable cover included. (with new wheelchair order, the breathable head rest cover will be delivered in same Betex-color as back cushion). Weight reduction approximately 700-1000g to other head rest systems.Only possible with stabilizer bar.Betex-colors:
grey red yellow green orange black blue
size 1 size 2
x 200 260
y 110 130
piece
286,- €286,- €276,- €276,- €276,- €276,- €276,- €276,- €60,- €
105,- €
