Sunrise Medical XT2 Powerchair Order Form and Specifications

Product Overview

The Sunrise Medical XT2 is a powerchair designed for mobility and independence. This document serves as an order form, allowing users to select various features and configurations.

Base Price: €22,000.00 (excluding VAT)

Order Information

The order form is divided into sections for billing and shipping information, as well as user details.

Billing Information (FATTURARE A)

• Company Name (Ragione Sociale)
• Address (Via)
• City (Città)
• Province / Postal Code (Provincia / C.A.P.)
• Email (e-mail)
• Telephone (Telefono)

Shipping Information (SPEDIRE A)

• Company Name (Ragione Sociale)
• Address (Via)
• City (Città)
• Province / Postal Code (Provincia / C.A.P.)
• Email (e-mail)
• Telephone (Telefono)
• Identical to billing address [checkbox]

Order Details (INFORMAZIONI SULL'ORDINE)

• Order Type: Order [✓] / Quote
• Order Number (N° Ordine)
• Article Number (Art. No.)
• Order Date (Data ordine)
• Refund Codes (Codici di rimborso) - refer to page 2

User Weight (PESO DELL'UTENTE)

• Maximum Load Capacity (Portata massima): 136 kg
• User Weight (Peso dell'utente): [input field] kg

Technical Specifications and User Measurements

User Measurements (MISURE DELL'UTENTE)

Measurements are provided in millimeters (mm) and relate to the user's body dimensions for seating and support:

• a) Head apex to seat
• b) Shoulder apex to seat
• c) Axillary fold to seat
• d) Shoulder width
• e) Trunk width
• f) Current wheelchair seat width
• g) Current wheelchair seat depth
• h) Popliteal fold to floor

A diagram illustrates these measurements.

Technical Data (Dati Tecnici)

Configuration Options

The following sections detail various customizable options for the XT2 powerchair:

Base Motor (Base motrice)

• Base Model: MAG010012 XT2

XT2 Colors (Colori XT2)

• Nero Midnight (Midnight Black)
• Rosso Sunset (Sunset Red)
• Blu Horizon (Horizon Blue)

Drive Wheels (Ruote Motrici)

• Pneumatic, low pressure
• Pneumatic with anti-puncture insert
• Neverflat (internal tire treatment to prevent pressure loss from accidental punctures)

Batteries (Batterie)

• 115 Ah Batteries [✓]

Battery Charger (Caricabatterie)

• Automatic 220V/12A Battery Charger [✓]

Seat Electronics Modules (Moduli elettronici della seduta)

• Electronic tilt from 0° to 50°
• Combined electronic lift (300 mm) and tilt from 0° to 45°

Seat Height to Floor (Altezza della seduta a terra)

(Does not include cushion height)

• 480 mm (max footrest length 370 mm)
• +25 mm (max footrest length 400 mm)
• +50 mm (max footrest length 430 mm)

Seat Type (Tipologia di seduta)

• MPS Seat, Vinyl upholstery (See Section A) (only with MPS backrest)
• MPS Seat, Fabric upholstery (See Section A) (only with MPS backrest)
• Rehab Seat, choose JAY cushion type

Section A - MPS Seat Cushion Measurements

Seat Cushion Width:

• MAGSW405MM: 405 mm
• MAGSW455MM: 455 mm
• MAGSW510MM: 510 mm
• MAGSW560MM: 560 mm

Seat Cushion Depth:

• MAGSD405MM: 405 mm
• MAGSD455MM: 455 mm
• MAGSD510MM: 510 mm

Note: For seat widths of 405 mm and 430 mm, seat depths greater than 455 mm are possible only with special production.

Section B - Rehab Seat Plate Measurements

Seat Plate Width:

• MAGSW305MM: 305 mm
• MAGSW330MM: 330 mm
• MAGSW355MM: 355 mm
• MAGSW380MM: 380 mm
• MAGSW405MM: 405 mm
• MAGSW430MM: 430 mm
• MAGSW455MM: 455 mm
• MAGSW480MM: 480 mm
• MAGSW510MM: 510 mm
• MAGSW535MM: 535 mm
• MAGSW560MM: 560 mm

Seat Plate Depth:

• MAGSD305MM: 305 mm
• MAGSD330MM: 330 mm
• MAGSD355MM: 355 mm
• MAGSD380MM: 380 mm
• MAGSD405MM: 405 mm
• MAGSD430MM: 430 mm
• MAGSD455MM: 455 mm
• MAGSD480MM: 480 mm
• MAGSD510MM: 510 mm
• MAGSD535MM: 535 mm
• MAGSD560MM: 560 mm
• MAGSD585MM: 585 mm
• MAGSD610MM: 610 mm

Section B - Rehab Seat Cushion (Cuscino per seduta Rehab)

• Without cushion (Senza cuscino)
• JAY Cushion: Choose JAY cushion, indicate code (see Jay section on our website)

Backrest Type (Tipologia di schienale)

• MPS Backrest (MPS) (only with MPS seat)
• Rehab Backrest (Rehab) (choose JAY backrest type)
• Rehab Foldable Backrest (Rehab abbattibile in avanti) (choose JAY backrest type)

MPS Backrest Upholstery (Rivestimento dell'imbottitura schienale MPS)

• Fabric Upholstery
• Vinyl Upholstery

MPS Backrest Upholstery Measurements

Backrest Upholstery Width:

• MAGBW405MM: 405 mm
• MAGBW455MM: 455 mm
• MAGBW510MM: 510 mm
• MAGBW560MM: 560 mm

Backrest Upholstery Height:

• MAGBH535MM: 535 mm
• MAGBH585MM: 585 mm

Backrest Recline Modules

MPS Seat Backrest Recline Modules (Moduli reclinazione dello schienale con seduta MPS)

• Manual recline from 90° to 170°
• Electronic recline from 90° to 150° (not in combination with MAG3502-KIT option)

Rehab Seat and Rehab Backrest Recline Modules (Moduli reclinazione dello schienale per la seduta Rehab e schienale Rehab)

• Manual recline from 90° to 170°
• Electronic recline from 90° to 160° (backrest height minus backrest width must exceed 50 mm)
• Electronic recline with compensation from 95° to 155° (not in combination with seat widths of 305 mm, 330 mm, and 355 mm) (backrest height minus backrest width must exceed 50 mm)

Rehab Seat Backrest Recline Modules with Foldable Backrest (Moduli reclinazione dello schienale per seduta Rehab con schienale abbattibile in avanti)

• Manual recline from 90° to 170°
• Electronic recline from 90° to 160° (backrest height minus backrest width must exceed 50 mm)
• Electronic recline with compensation from 95° to 155° (not in combination with seat widths of 305 mm, 330 mm, and 355 mm) (backrest height minus backrest width must exceed 50 mm)

Rehab Backrest, JAY Backrest Type (Schienale Rehab, tipologia di schienale JAY)

• JAY J3 Backrest: Choose JAY backrest, indicate code (see Jay section on our website) (select without backrest padding)

Push Handles and Backrest Accessories

Push Handles (Maniglie di spinta)

• Push handle for MPS backrest (only with MPS backrest)
• Height-adjustable push handles for MPS backrest (only with MPS backrest)
• Push handles for Rehab backrest

Backrest Accessories (Accessori dello schienale)

• Backpack hooks, mounted on MPS backrest (pair)
• Backpack hooks, mounted on Rehab push handle

Headrest Type (Tipologia di appoggiatesta)

• MPS Headrest (MPS) (only with MPS backrest) (Upholstery will match the MPS backrest)
• Whitmyer Headrest: Choose Whitmyer headrest (only with JAY backrest) (see Whitmyer section on our website) (indicate padding code) (includes mounting bracket and attachment plate)

Armrest Types and Options

Armrest Types (Tipologia di braccioli)

• Standard Single Post, Removable
• Standard Single Post, Removable with Reinforcement (for bariatric users)
• Flip-up (flexi)
• Flip-up with seat support stem (flexi)
• Flip-up with seat support stem for position lock (flexi)
• Flip-up with seat support stem and fold-down (flexi) (to facilitate approach to tables)

Diagrams illustrate different armrest types.

Armrest Upholstery Adjustment (REGOLAZIONE DELL'IMBOTTITURA DEI BRACCIOLI)

• Lateral adjustment in 7 mm increments
• Forward and backward adjustment - 70 mm
• Rotation +/- 12°

Armrest Upholstery (IMBOTTITURE DEI BRACCIOLI)

• MPS Upholstery (355 mm short, 405 mm standard, 460 mm long)
• MPS, Flip-up Laterally (305 mm, 355 mm, 380 mm)
• Waterfall Upholstery (255 mm, 305 mm, 355 mm, 380 mm)
• Gutter Upholstery (75 mm)

Optional palm support for Gutter armrests (not recommended with MPS backrest).

Armrest upholstery lengths are adapted to seat depth. Refer to the table for details.

Armrest Upholstery Type (Tipologia di rivestimento dei braccioli)

• Vinyl Upholstery
• Fabric Upholstery

Armrest Options (Opzioni dei braccioli)

• Bag hooks, attached to the right armrest
• Bag hooks, attached to the left armrest

Footrest Height and Types

Footrest Plate Height (Altezza del piatto pedana)

Various height options are available, specified in millimeters (mm), with notes on compatibility with seat height options.

Footrest Type (Tipologia di pedana)

• Central Footplate (calf supports not included)
• Central Elevating Footplate (electronically) (calf supports included)
• Swing Away Footplates (70°)
• Manually Elevating Swing Away Footplates (calf supports not included)
• Electronically Elevating Swing Away Footplates (calf supports not included)

Diagrams illustrate different footrest types.

Footplate (Piatto pedana)

• Single flip-up footplate, 260 mm width (only with central footplate)
• Separate flip-up footplates, 260 mm width (only with central footplate)
• Single flip-up footplate (only with electronically elevating central footplate)
• Separate flip-up footplates (only with electronically elevating central footplate)
• Separate flip-up footplates (only with swing away footplates)

Footrest Accessories (Accessori delle pedane)

• Locking mechanism for separate swing away footplates

Calf Supports (Supporti per i polpacci)

• Calf supports (not required with the single electronically elevating central footplate)

Knee Padding (Imbottiture per le ginocchia)

• Knee padding
• Knee padding for central elevating footplate (manual and electronic)
• Knee padding for 70° swing away footplates
• Knee padding for elevating swing away footplates

Diagrams show knee padding installation for different footplate types.

Belts (Cinture)

• Wrap-around belt with auto-buckle for Rehab seat
• Left attachment
• Right attachment
• Wrap-around belt with auto-buckle for MPS seat
• Left attachment
• Right attachment

Joystick and Control Options

Joystick R-Net Options

• R-Net Joystick with LEDs
• R-Net Joystick with Color LCD
• R-Net Joystick with Color LCD ADVANCE, includes IR and Bluetooth (Android, Windows, and iOS)

R-Net Display Language (Lingua del display R-Net)

• Italiano [✓]

Switch Box CTRL5

• Switch Box CTRL5 with buttons
• Switch Box CTRL5 with levers

Switch Box CTRL5 Mounting Position

• Mounting on armrest, same side as joystick
• Mounting on armrest, opposite side of joystick
• Mounting for attendant (mounted on the rear of the push handle)

Joystick Grips (Impugnature del joystick)

• Standard Grip
• Long Lever Grip, 80 mm
• Chin Recess Grip, 38 mm diameter
• Ball Grip, 32 mm diameter
• Ball Grip, 38 mm diameter
• Mushroom Grip, 48 mm diameter
• T-Bar Grip, 80 mm width
• Soft Ball Grip, 70 mm diameter

Images display various joystick grip types.

Joystick Positioning (Posizionamento del joystick)

• Right
• Left
• Interchangeable right/left
• Attendant control mounted on the right, for MPS backrest
• Attendant control mounted on the left, for MPS backrest
• Attendant control mounted on the right, for Rehab backrest
• Attendant control mounted on the left, for Rehab backrest

Joystick Mounting and Alternative Controls

Joystick Mounting Bracket (Braccetto di montaggio del joystick)

• Fixed
• Swing away outwards (with magnet)
• Swing away inwards (with magnet)
• Swing away outwards with latch
• Swing away inwards with latch

Diagrams illustrate different mounting bracket types.

Joystick Mounting Anchor Support (Supporto di ancoraggio per il joystick)

• Adjustable height for fixed joystick mounting bracket
• Adjustable height for swing away joystick mounting bracket
• Removable for fixed joystick mounting bracket
• Removable for swing away joystick mounting bracket

Alternative Controls (Controlli alternativi)

• R-Net OMNI2 Module with integrated Bluetooth and IR (includes interface for special controls)

OMNI2 Mounting Position

• Left
• Right

Attendant Control (Comando per accompagnatore)

• Standard attendant control, for MPS backrest
• Standard attendant control, for Rehab backrest

Attendant Control Mounting Position

• Left
• Right

Accessories and Tables

Accessories (Accessori)

• Cup holder RAM®
• Magic Mobility steel cup holder
• Magic steel cup holder and phone holder combination
• USB charging ports (2xUSB and 1x12V) - attached to the seat's side rail, same side as joystick
• USB charging ports (2xUSB) - attached to the seat's side rail, opposite side of joystick
• USB charging ports (2xUSB) - attached to the seat's side rail, same side as joystick
• USB charging ports (2xUSB) - attached to the armrest, opposite side of joystick
• Enhanced horn
• Accessory bag (attached to backrest)
• Accessory bag (attached to right armrest)
• Accessory bag (attached to left armrest)
• Accessory bags (attached to both armrests)
• Wheelchair cover

Tables (Tavolini)

• Transparent table with containment edges (mounting on the side opposite the joystick)
• Transparent table with single attachment for hemiplegic, 320 x 240 mm (not in combination with interchangeable joystick mounting)
• Transparent swing away table with single attachment (from armrest to armrest)

Diagrams illustrate table types and mounting.

Footplate and Knee Padding Details

Footplate Types (Tipologie pedane)

• Central Footplate
• Central Elevating Footplate (Electronic)
• Swing Away Footplate
• Swing Away Elevating Footplate (Electronic)

Diagrams show different footplate configurations.

Lock for Swing Away Footplates (Blocco per le pedane swing away)

Diagram illustrates the locking mechanism for swing away footplates.

Accessories and Bag Details

Knee Padding (Imbottiture per le ginocchia)

Diagrams show knee padding installation for various footplate types.

Accessories (Accessori)

A diagram shows a cup holder with a diameter of 84 mm.

Bag and Table Options

Accessory Bag (Borsa portaoggetti)

Dimensions are provided: 85 mm (max width), 350 mm (width), 290 mm (height).

Tables (Tavolini)

• Transparent Table with Containment Edges
• Transparent Table with Single Attachment for Hemiplegic, 320 x 240 mm
• Transparent Swing Away Table with Single Attachment (from armrest to armrest)

Diagrams illustrate table mounting and types.

Final Pricing and Signature

Extreme XT2

• Base Price (VAT 4% excluded): €22,000.00
• Options (VAT 4% excluded): [input field]
• Total Price (VAT 4% excluded): [input field]

Signature and Date

• Date (Data): Day, Month, Year
• Signature (Firma): [input field]

Manufacturer Information

Sunrise Medical S.r.l.

Via Riva, 20 - Montale

29122 Piacenza - Italia

Tel.: +39 0523 573111

Fax: +39 0523 570060

Email: info@sunrisemedical.it

Website: www.SunriseMedical.it