Quickie All Court®
EISP1, Effective January 2016
ACCOUNT INFORMATION
Account No: ___________________________________________________________________________________
Drop Ship/Ship To: _________________________________________________
Date: ________________________________________________________________________
Name: ___________________________________________________________
P.O. #: ________________________________________________________________________
Address: _________________________________________________________
Buyer: _________________________________________________________________
City: _________________________________________________________
State:______________________
Marked For: _________________________________________________________________________
Zip Code:_____________________________
Phone Number:_________________________
The HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payor's coverage policy.
1. FRAME
155WM14
Base Frame
155BF01
155BF02
155BF03
Base Model
New All Court Model
Standard
Single Intergral Anti-Tip
Dual Integral Anti-Tip
$2,695.00
Frame Type
155FT6
155FT57
Basketball Single Wing
BB Single Wing W/Stand Up
NC
$100.00
NC
NC
$100.00
Includes 5th Wheel Support at No Charge
2. SIZE / SEATING
Frame Length
155FL50
SEAT MATRIX
Frame Length Short 15"
NC
NA w/ 17-20" Seat Depth
155FL51
Frame Length Medium 17"
NC
NA w/ 10-11" or 19-20" Seat Depths
155FL52
155FL53
Frame Length Long 19"
Frame Length X-Long 21"
Seat Width (See Seat Matrix)
155S3
12" Seat Width
155S4
13" Seat Width
155S5
14" Seat Width
155S6
15" Seat Width
155S7
16" Seat Width
155S8
17" Seat Width
155S9
18" Seat Width
155S10
19" Seat Width
155S47
20" Seat Width
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
155SL1
155PN5
SEATING OPTIONS
Seat Sling Standard
Seat Pan Half Deep
Cushion
155CU1
Cushion 2"
Front Seat Height
155SH14
155SH16
155SH18
155SH21
155SH24
155SH27
16" Front Seat Height
17" Front Seat Height
18" Front Seat Height
19" Front Seat Height
20" Front Seat Height
21" Front Seat Height
NC
$70.00
$120.00
Optional Seat Width
1/2" Seat Width is built-in when selecting Aluminum Side Guards
155OW1
1/2" Seat Width
Seat Depth (See Seat Matrix)
155SD3
10" Seat Depth
155SD4
11" Seat Depth
155SD5
12" Seat Depth
155SD6
13" Seat Depth
155SD7
14" Seat Depth
155SD8
15" Seat Depth
155SD9
16" Seat Depth
155SD10
17" Seat Depth
155SD11
18" Seat Depth
155SD12
19" Seat Depth
155SD73
20" Seat Depth
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.com
Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical. Quickie All Court - Page 1 of 3 MK-100026 REV B
NC
NC
NC
NC
NC
NC
Quickie All Court, September 2015
3. CASTERS
Caster
155CW1
3" Micro
NC
4. REAR WHEELS
Rear Seat Height
155RH11
155RH13
155RH15
155RH17
155RH19
155RH20
155RH21
155RH22
155RH23
13" Rear Seat Height
14" Rear Seat Height
15" Rear Seat Height
16" Rear Seat Height
17" Rear Seat Height
18" Rear Seat Height
19" Rear Seat Height
20" Rear Seat Height
21" Rear Seat Height
NC
NC
NC
NC
NC
NC
NC
NC
NC
Rear Wheel Tire
155RT31
155RT5
Handrim
155HR1
155HR4
155HR7
Handrim Tab
24" X/S Spoke Wheel (540)
24" X/S QP HT Tnns (559)
24" X/S QP HT BB (559)
26" X/S QP HT BB Wheel (590)
26" X/S QP HT BB Whl (700C)
24" Spinergy Whl 540 Blk
24" Spinergy Whl 559 Blk
26" Spinergy Whl 590 Blk
Omit Rear Wheel & Axle (540)
Omit Rear Wheel & Axle (559)
Omit Rear Wheel & Axle (590)
Omit Rear Wheel & Axle (700C)
NC
$275.00
$275.00
$275.00
$275.00
$795.00
$795.00
$795.00
NC
NC
NC
NC
Aluminum Handrim Anodized
Plastic Coat Handrim
Omit Handrim
NC
NC
NC
$95.00
NC
Only avaialble with cross spoke (x/s) wheels
155TB1
Rear Wheel
155RW53
155RW69
155RW70
155RW66
155RW72
155RW57
155RW59
155RW61
155RW63
155RW64
155RW65
155RW71
High Pressure Clincher Tire
Turbo Tread Tire
Camber Tube
155CI10
155CI11
Handrim Regular Tab
NC
16 Degree Camber
20 Degree Camber
NC
NC
Axle
155AX4
155AX11
QR Steel
Quad QR Axles
NC
$90.00
x`
5. FOOTREST
Footrest
Adaptive Platform Spacer
155F234
155F39
Footrest Options
155IG20
Platform
High Mount Platform
NC
NC
Neoprene Impact Guards
NC
NA w/ High Mount Platform Footrest
155AD1
155AD2
155AD3
Adaptive Platform 2" Spacer
Adaptive Platform 4" Spacer
Adaptive Platform 6" Spacer
$95.00
$95.00
$95.00
Back Upholstery Std
Back Upholstery Adj Sports
Back Upholstery Omit
NC
$150.00
-$15.00
6. BACKREST / SEATING
Back Type
155BT1
155BT3
Folding Backrest
Non Folding Backrest
NC
NC
Back Height
155B128
155B133
156B83
155B134
155B135
9"
Fixed 10 - 13"
Fixed 12 - 16"
Fixed 15 - 18"
Fixed 17 - 20"
NC
NC
NC
NC
NC
Back Upholstery
155BU1
155BU13
155BU14
7. SIDE GUARDS
Side Guard
155SG4
155SG3
155SG5
Plastic Side Guard Kids
Plastic Side Guard Reg
Alum Side Guard Reg
$125.00
$125.00
$175.00
Alum Side Guards required for the 1/2" seat width option
ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.com
Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical. Quickie All Court - Page 2 of 3 MK-100026 REV B
Quickie All Court, September 2015
8. KEY OPTIONS AND ACCESSORIES
Anti-Tip
155AT39
155AT40
Rear Anti Tip Integral
Rear Anti Tip Quick Release
NC
$90.00
Backpack
155A1
155A2
Black Utility Backpack
Back Pack Blk/Charcoal Kids
$55.00
$50.00
Seat Pouch
155A8
Seat Pouch Black/Charcoal
$45.00
Positioning Belt
155A17
155A18
155A190
155A191
Hook & Loop Closure
Nylon Buckle Closure
Ratchet Pos Belt Lrg
Ratchet Pos Belt X-Lrg
$60.00
$60.00
$90.00
$90.00
Spoke Guard
155A24
155A23
155A25
Spoke Guard - Clear
Spoke Guard - Black
K0065 Spoke Guard Sport Hi-Profile
K0065
K0065
$115.00
$115.00
$120.00
Only available in Black
155A26
K0065
Spoke Guard Sport Low-Profile
$120.00
Only available in Black
Chest Straps
155A103
155A106
Accessories Misc
155A90
Chest Strap 2" (48" Length)
Chest Strap 4" (48" Length)
$30.00
$40.00
Pad For Backrest Crossbar
$30.00
Required for Tournament play
155A98
155A180
155A181
Tire Pump
Toe Clips
5th Wheel Support
$80.00
$50.00
$110.00
MATTE FRAME COLOR
155C116
155C151
155C150
155C149
155C152
Matte Black
Matte Black Cherry
Matte Electric Blue
Matte Evergreen
Matte Purple
NC
NC
NC
NC
NC
9. COLOR
FRAME COLOR
155C140
155C2
155C141
155C10
155C38
155C36
155C14
155C35
155C142
155C143
155C126
155C144
155C147
155C148
155C103
155C114
155C145
155C113
155C8
Aztec Gold
Black (Not avail as base w/Zebra)
Black Cherry
Black Opal
Blue Opal
Candy Blue
Candy Purple
Candy Red
Electric Blue
Evergreen
Glow
Green Applie
Hot Sparkle Pink
Mauve Pink
Rootbeer
Sparkle Silver
Sunrise Orange
Titanium Color Paint
Yellow
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
CUSTOM FRAME COLOR
155C112
Desert Camouflage
155C43
Mossy Oak Camouflage
155C42
Stars & Stripes
155C108
Zebra (Choose above base color)
$295.00
$295.00
$295.00
$295.00
Std with White unless above base paint is chosen
NA w/ Blck, Matte Black, Blck Opal or Titanium
ORDERING INFORMATION PHONE: (800) 333-4000, FAX: (800) 300-7502, WEBSITE: www.sunrisemedical.com
Specifications are subject to change without notice. Copyright @ 2009, Sunrise Medical. Quickie All Court - Page 3 of 3 MK-100026 REV B