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Page 1 of 2INFINFB3830/RevA/01OCT2021
Zero Turn 8 (Jazzy® Zero Turn) Scooter Order Form
Pride® Mobility Products Corporation401 York Avenue, Duryea, PA 18642Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: [email protected]
Account Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _____________________________________
Marked for: _____________________________________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
INTRODUCTION
MODELREQUIRED. Weight capacity: 325 lbs. Find more details and specifications at pridemobility.com/jazzy-zero-turn-4-wheel.
Zero Turn 8 4-Wheel Scooter ........................................$2,579Part: JAZZYZTS HCPCS: K0899 — Power Mobility Device, not coded by DME PDAC or does not meet criteria.
• 3.5-amp off-board charger• 22Ah battery box• Front basket• Flat-free tires• iTurn Technology®
• USB charging port• Front and rear lighting• Full suspension• Compact, foldable seat
(17″W × 17″D)
Standard Features
COLORREQUIRED. Colors shown here may differ from actual product depending on monitor/printer calibration.
Pearl WhitePart: DGN1700442
Fire OpalPart: DGN1706351
Sapphire BluePart: DGN1706350
Onyx BlackPart: DGN1706349
PewterPart: DGN1706352
Green MoonstonePart: DGN1706482
ACCESSORIESOptional.
50″ Lap Belt .......................... StandardPart: ACCBELT1000
Cell Phone Holder .......................... $70Part: ACC145549
Cup Holder, Style C ....................... $30Part: ACCASMB2288
Rearview Mirror .............................. $35Part: LGTRMIR1003
Saddle Bag (12.5″ × 9.875″) ............ $40Part: DWR1020D010
Safety Flag ...................................... $38Part: ACC151932
22Ah Battery Box (Spare) ........... $515Part: BAT167763
Micro Black Weather Cover ........ $140Part: ACCCOVR1020
Under-Seat Storage ....................... $80Part: ACC160129
Rear Basket (15.25″ × 9.75″ × 9.5″) ..$90 Part: ACCBSKT1010
Oxygen Tank Holder ...................... $98Part: ACCASMB1017
Walker Holder ................................. $98Part: ACCASMB1018
Back-Mounted AccessoriesOptional. Only one back-mounted accessory can be used at a time. Includes mounting bracket and hardware.
This form is interactive when viewed in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete scooter. Pride Providers may contact Technical Services for accurate parts ordering.
Thank you for choosing Pride Mobility Products!
FDA Class II Medical Device*
Page 2 of 2INFINFB3830/RevA/01OCT2021
Pride® Mobility Products Corporation401 York Avenue, Duryea, PA 18642Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: [email protected]
COMMENTS
BRANCH PATCHESOptional.
Air Force Patch ............................... $20Part: ACC140240
Army Patch ..................................... $20Part: ACC140241
Coast Guard Patch ........................ $20Part: ACC140239
Marines Patch ................................. $20Part: ACC140243
Navy Patch ...................................... $20Part: ACC140244
Purple Heart Patch ........................ $20Part: ACC140238
© 2021 Pride Mobility Products Corp. All rights reserved.
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CANE/CRUTCH HOLDEROptional. Only one cane/crutch holder can be used at a time.
Wishbone Crutch Holder .............. $98Part: FRMASMB2358
Forearm Crutch Holder ................. $98Part: ACCASMB1019
Single Rear Mount, 3″.................... $70Part: ACCINDV1058
Double Rear Mount, 3″ .................. $70Part: ACCINDV1019
*Pride® Travel Mobility Scooters are FDA Class II Medical Devices designed to aid individuals with mobility impairments.
