Convaid Trekker Canadian Retail Price List / Order Form Account #:_____________________________________ Purchase Order #:_____________________________ Date:______________________ Contact:______________________________________________ Mark For:_________________________________________________ Bill To: Ship To: Address: Address: City/State/Zip: Phone: Fax: City/State/Zip: Email: Phone: Trekker Base Standard Features: ● Tilt-in-Space Base (-5 to +45 degrees) ● Reversible Seating Configuration ● Quick Release Rear Wheels ● Foot Activated Wheel Locks ● Depth Adjustable Seat Pan ● 90 Degree Fixed Front Rigging ● 90 Degree Fixed Foot Plate *** ● One-Piece Height Adjustable Push Handle (Outside Mount) ● Silver Powder Coated Frame *** ● Seat to Back Angle (80 to 110 degrees) ● Closure Strap *** ● 7 1/2" x 2" Front and 11 1/2" x 2 1/2" Rear Wheels ● Made in the USA *** *** Standard Models: Trekker TR12 - 904660 Trekker TR14 - 904661 Price $2,515 $2,515 Trekker Seating Module Back Module Options - Select one below: Back Canes Only Height Adjustable Solid Back System with Cushion and Hip Protector Back Cushion: Back Cushion - Short (12: 12x18) Back Cushion - Short (14: 14x22) Back Cushion - Tall (12: 12x21) Back Cushion - Tall (14: 14x26) Upholstery Color: Panther Black Royal Blue Chocolate Brown Forest Green Sassy Purple Princess Pink Cherry Red Aqua Blue Apple Green Tangerine Orange Back Cushion Options 1" Open Cell Foam Insert Short Back 1" Open Cell Foam Insert Tall Back 1/2" Soft Cool Viscoelastic Foam Insert Short Back 1/2" Soft Cool Viscoelastic Foam Insert Tall Back Lumbar Support Contoured Seat Cushion Contoured Seat Cushion - Short (12: 12x9) Contoured Seat Cushion - Short (14: 14x13) Contoured Seat Cushion - Long (12: 12x12) Contoured Seat Cushion - Long (14: 14x16) Planar Seat Cushion Planar Seat Cushion - Short (12: 12x9) Planar Seat Cushion - Short (14: 14x13) Planar Seat Cushion - Long (12: 12x12) Planar Seat Cushion - Long (14: 14x16) Seat Cushion Options 1" Open Cell Foam Insert Short Seat 1" Open Cell Foam Insert Long Seat 1/2" Soft Cool Viscoelastic Foam Insert Short Seat* 1/2" Soft Cool Viscoelastic Foam Insert Long Seat* *Can only be ordered with Planar Seat Cushion. Transit Items Transit Option (Manufacturer Installation Required)*** Head Support - Select Type Below: Height Adjustable Curved Head Support Adjustable Wing Head Support Using other manufacturer's Head Support Q'Straint Transit Lap Belt Sure-Lok Transit Lap Belt *** *** Price TR12 TR14 N/C $551 904768 904662 904769 904663 N/C N/C N/C N/C 904696 N/A 904697 N/A N/A 904698 N/A 904699 N/C N/C N/C N/C N/C N/C N/C N/C N/C N/C 903854 903850 904189 903857 903851 903759 903855 904753 904754 904752 903854 903850 904189 903857 903851 903759 903855 904753 904754 904752 $37 $37 $68 $68 $37 904700 904701 904702 904703 904664 904704 904705 904706 904707 904664 $342 $342 $342 $342 904780 N/A 904782 N/A N/A 904781 N/A 904783 $310 $310 $310 $310 904708 N/A 904709 N/A N/A 904710 N/A 904711 $37 $37 $63 $63 904712 904713 904714 904715 904716 904717 904718 904719 Price $210 TR12 904576 TR14 904576 $236 $278 $0 $95 $95 904583 904584 995681 903094 903232 904607 904608 995681 903094 903232 ***The Trekker Transit option includes four manufacturer installed red wheelchair transportation anchors. The Trekker Transit model has been crash tested and conforms to RESNA WC19 standards. Anthropomorphic Test Device weights are TR12T 75lbs/34kg and TR14T 110lbs/50kg. The Convaid Trekker Mobility Base was tested with the Trekker Seating Module equipped with a head support and wheelchair anchored pelvic lap belt. Do not use the foot positioners on the Convaid Trekker during transit in a motor vehicle. The performance and safety of accessories and/or other seating options not tested by Convaid is unknown, and no warranty or claim about their performance is or can being made. Furthermore, when being transported in a vehicle it is Convaid’s position that the wheelchair user transfer from the wheelchair into appropriate vehicle seating during transportation. Please note that at this time, the Department of Transportation has not officially approved any tie-down system for a user while in a wheelchair, therefore Convaid cannot recommend a transit system. For more information on RESNA WC-19 and WC-20 standards please visit http://www.rercwts.pitt.edu/WC19.html. Page 1 of 2 12/19/2014 Canadian Retail Price List / Order Form Convaid Trekker Pelvic Positioning 2-Point Pelvic Positioning Belt 3-Point Pelvic Positioning Belt w/ Adjustable Crotch Strap ^^ 4-Point Pelvic Positioning Belt - XS Bodypoint® 4-Point Pelvic Positioning Belt - S Bodypoint® 4-Point Pelvic Positioning Belt - M Bodypoint® 4-Point Pelvic Positioning Belt w/Security Cover - XS Bodypoint® 4-Point Pelvic Positioning Belt w/Security Cover- S Bodypoint® 4-Point Pelvic Positioning Belt w/Security Cover - M Bodypoint® Width Adjustable Lateral Pelvic Support - Left (Hip Guide) Width Adjustable Lateral Pelvic Support - Right (Hip Guide) Price $47 $51 $158 $158 $158 $185 $185 $185 $121 $121 $152 $152 TR12 904559 904017T 904681 904682 904683 904684 904685 904686 904667 904668 904611 904612 TR14 904559 904017T 904681 904682 904683 904684 904685 904686 904669 904670 904613 904614 Foot & Leg Positioning Angle Adjustable Elevating Leg Rest (Left) Angle Adjustable Elevating Leg Rest (Right) Angle Adjustable Foot Support - Reversible - Flip Up Medial Knee Abductor - Small Medial Knee Abductor - Medium Foot Positioners - Small 7" - 10" (pair)** Foot Positioners - Medium 8" - 11" (pair)** Foot Positioners - Large 9" - 12" (pair)** Shoe Holders w/ Padded Straps - Small, Therafin (pair)** Shoe Holders w/ Padded Straps - Medium, Therafin (pair)** Calf Panel **Cannot be used during transit. Price $131 $131 $116 $170 $170 $164 $164 $164 $197 $197 $64 TR12 904756 904757 904568 904557 904591 904771 904772 904773 904679 904680 904580 TR14 904758 904759 904596 904557 904591 904771 904772 904773 904679 904680 904580 Trunk Positioning H-Harness w/ Padded Covers^^^ Extended Strap Vest (Butterfly Harness) - EI Therafin Extended Strap Vest (Butterfly Harness) - S Therafin Extended Strap Vest (Butterfly Harness) - M Therafin Width Adjustable Thoracic Lateral Support (Left)**** Width Adjustable Thoracic Lateral Support (Right)**** ^^^Requires the Height Adjustable Solid Back System and 3-Point Belt. ****Requires the Height Adjustable Solid Back System. Price $137 $185 $185 $185 $152 $152 TR12 904695 904676 904677 904678 904760 904761 TR14 904695 904676 904677 904678 904760 904761 Head Supports Height Adjustable Curved Head Support**** Adjustable Wing Head Support**** Universal Head Support Mounting Plate (Accomodates most manufacturer's head supports) ****Requires the Height Adjustable Solid Back System. Price $236 $278 $58 TR12 904583 904584 904672 TR14 904607 904608 904672 Frame Option Recline System (80 to 170 degrees) Height Adjustable Push Handle (Inside Mount) Price $504 N/C TR12 904673 904687 TR14 904674 904687 Tire Options 12 1/2" Rear Solid Knobby Tire 7.5" x 2" Front, 12.5" Rear Pneumatic Knobby Tire Price $209 $314 TR12 904117 904118 TR14 904117 904118 Medical Support Accessories IV Pole (height adjustable and collapsible)° O2 Tank Holder LTV Ventilator Holder (Includes female Dovetail Bracket)° Ventilator/Suction/Hard Tray °Requires Rear Anti-Tip Tubes. Price $158 $184 $473 $473 TR12 904566 904565 904671 904567 TR14 904566 904565 904671 904595 Accessories Upper Extremity Support Tray - Fixed (Hardware Included)*^ Padded Tray Cover*°° Headrest Cover (Canopy)**** Extended Headrest Cover - No Windows (Canopy)**** Extended Headrest Cover - with Windows (Canopy)**** Caster Locks Rear Anti-Tip Tubes Under Seat Storage Basket Medical Necessity Storage Basket Utility Bag Replacement Cushion Covers: Select Color____________ Seat Cushion - Short (12: 12x9; 14: 14x12) Seat Cushion - Long (12: 12x12; 14: 14x16) Back Cushion - Short (12: 12x18; 14: 14x21) Back Cushion - Long (12: 12x21; 14: 14x26) *Cannot be used during transit. °°Requires Upper Extremity Support Tray. ****Requires the Height Adjustable Solid Back System. ^Not available with arm rests. Price $362 $68 $239 $268 $310 $99 $121 $126 $310 $40 TR12 904556 904586 904572 904690 904573 904689 904649 904581 904582 904531 TR14 904590 904610 904599 904691 904600 904689 904649 904605 904606 904531 $342 $342 $342 $342 904563 904762 904763 904764 904593 904765 904766 904767 Width Adjustable Lateral Pelvic Support with Armrest - Left (Hip Guide with Armrest) Width Adjustable Lateral Pelvic Support with Armrest - Right (Hip Guide with Armrest) ^^Trekker Seat Cushion Required. HCPCS codes are provided for your convenience and are NOT to be considered billing or legal advice. Providers are responsible for insuring that appropriate billing codes are used when submitting claims. Proper use of HCPCS codes does not insure coverage or payment. Contact the appropriate payer for coverage information. Standard Domestic Shipping Rate: $40 • For expedited shipping rates, please call 1-888-CONVAID www.convaid.com 2830 California St., Torrance, CA 90503 • 1-888-CONVAID (266-8243), 310-618-0111 • Fax: 310-618-2166 Prices in USD & subject to change, ex works Torrance, California. Effective: 1/1/2015 Page 2 of 2 Rev 1 12/19/2014
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