Sunrise Medical Acky Tricycle Order Form

Customer/HMS: Contact Person: Email: Phone: Order Date: Salesperson: Order No.: Comments:

Order Price Quote Special Adaptation (Built 4 Me)

Delivery Information

Deliver to: Use Ref: Email: Phone: Mark:

Sunrise Order No.:

[ ] = Standard [ ] = Accessory/Price Change [ ] = Option without extra cost

Customer Service Email: mailordre@sunrisemedical.no

Max Person Weight: 35 kg CHILD'S WEIGHT: [ ]

Main Product: Acky Tricycle

Acky is available in 4 different versions, and the frame comes in 3 different editions (std, LS, and E).

Max Person Weight: 35 kg

Child's Weight: [ ]

Acky Models

Acky (Part Contract 3: Pedal Brake)

Delivery Art. No: N740206 HMS Art. No: 315324

Description: Tricycle 3-wheel, 7 gears, handbrake/pedal brake, step-in height 14 cm. Acky frame (red and yellow) with closed chain guard. Handbrake, parking brake, 16" front wheel with fender, 12" rear wheels with fenders, aluminum rims, bell, and luggage carrier.

[ ] Pedal Brake

Acky (Part Contract 4: Freewheel)

Delivery Art. No: N740207 HMS Art. No: 315323

Description: Tricycle 3-wheel, 7 gears, handbrake, step-in height 14 cm. Acky frame (red and yellow) with closed chain guard. Handbrake, parking brake, 16" front wheel with fender, 12" rear wheels with fenders, aluminum rims, bell, and luggage carrier.

[ ] Freewheel

Acky E (Part Contract 6: With Electric Motor)

Delivery Art. No: N740341 HMS Art. No: 315321

Description: Tricycle Acky PAS, 7 gears, handbrake, electric motor Bafang 250W with start assist.

Note on motor power: As standard, the motor is programmed to provide assistance up to 25 km/h and start assistance up to 6 km/h. If a lower maximum speed is desired, and/or to adjust the motor's power output relative to the user's leg power, contact a Sunrise Medical representative for correct settings.

[ ] Acky E (Part Contract 6: With Electric Motor)

Acky E (Part Contract 6: With Electric Motor) - Pedal Brake Version

Delivery Art. No: N740342 HMS Art. No: 315322

Description: Acky frame (red and yellow) with closed chain guard. Handbrake, parking brake, 16" front wheel with fender, 12" rear wheels with fenders, aluminum rims, bell, and luggage carrier.

[ ] Pedal Brake

Acky LS (Not in contract with NAV)

Delivery Art. No: N740211 HMS Art. No: N/A

Description: Acky frame (red and yellow) with closed chain guard. Handbrake, parking brake, 16" front wheel with fender, 12" rear wheels with fenders, aluminum rims, bell, and luggage carrier.

Features: Freewheel, 0 gears.

Standard Features for Acky Models:

Steering lock to limit uncontrolled steering movements.
Closed chain guard for increased safety and reduced maintenance.
Handbrake adapted for small children's hands.
Parking brake.
Sturdy luggage carrier.
Cambered rear wheels for a lower center of gravity and easier maneuvering.
Smaller rear wheels for a lower center of gravity and increased stability.
Aluminum rims (16" front and 12" rear).
Bell.

Specific Features by Model:

Acky DK 3 (Pedal Brake): 7 gears, Pedal brake.
Acky DK 4 (Freewheel): 7 gears, Freewheel.
Acky E DK 6 (2 Series): 7 gears, Freewheel or pedal brake, Bafang 250W electric motor with start assist.
Acky LS: Freewheel, 0 gears, Guide control with push bar.

Pedals

Order	Delivery Art. No.	HMS Art. No.	Pedals	Illustrations
[ ]	AAND.100755	266525	Standard Pedals (set)
[ ]	OPTI.005050AL	192837	Pedal strap equalization weight fabric strap left
[ ]	OPTI.005050AR	192836	Pedal strap equalization weight fabric strap right
[ ]	OPTI.005050BCDL	192813	Pedal with strap and equalization weight plastic strap BCD left
[ ]	OPTI.005050BCDR	192815	Pedal with strap and equalization weight plastic strap BCD right
[ ]	OPTI.005051AL	192839	Pedal Acky toe clip equalization weight left
[ ]	OPTI.005051AR	192838	Pedal Acky toe clip equalization weight right
[ ]	OPTI.005060AL	192831	Pedal footrest equalization weight velcro W:70mm, L:165mm left
[ ]	OPTI.005061AR	192830	Pedal footrest equalization weight velcro W:70mm, L:165mm right
[ ]	OPTI.005043AL	251697	Pedal Acky footrest calf support reg W:70mm, L:165mm left
[ ]	OPTI.005044AR	251701	Pedal Acky footrest calf support reg W:70mm, L:165mm right
	OPTI.005063	192922	Wire routing Acky for pedal position
	OPTI.005102	192852	Crank shortener Acky left
[ ]	OPTI.005103	192851	Crank shortener Acky right
	OPTI.005100	spec *)	Crank articulated left 1)	Fill in dimensions below
	OPTI.005101	spec *)	Crank articulated right 1)	Fill in dimensions below
*) Dimensions must be provided:			Total length:	Hub to mount
			Length A:	Hub to joint
			Length B:	Joint to mount

1) Special adaptation, allow for longer delivery time.

Seats

Order	Delivery Art. No.	HMS Art. No.	Seat
(2)	ZADE.15080	031099	Standard Seat Acky models
	ZADE.150226	242509	T-post bicycle for depth displacement
	ZADE.15008		Seat post without depth adjustment (For 3-4cm shorter inseam)
[ ]	OPTI.005080S	266399	Bicycle seat wide
[ ]	OPTI.005081	192878	Banana saddle
[ ]	OPTI.005085	231618	Abduction seat small
[ ]	OPTI.005086	231619	Abduction seat large

Backrests and Belts

Order	Delivery Art. No.	HMS Art. No.	BACKREST AND BELT	Quantity
[ ]	OPTI.005091AB	192770	Bicycle backrest 31 cm buckle.
[ ]	OPTI.005091CD	192768	Bicycle backrest 43 cm buckle.
[ ]	OPTI.005092AB	192769	Bicycle backrest 31 cm Velcro.
[ ]	OPTI.005092CD	192767	Bicycle backrest 43 cm Velcro.
[ ]	OPTI.005090A	192875	Backrest without belt depth 31 width 25.
[ ]	OPTI.005090B	192869	Backrest without belt depth 33 width 28.
[ ]	OPTI.005090C	192870	Backrest without belt depth 43 width 35.
[ ]	OPTI.005090D	192872	Backrest without belt depth 51 width 43.
[ ]	OPTI.005045	234337	Backrest hoop, adjustable low (42 cm)
[ ]	OPTI.005046	233667	Backrest hoop, adjustable high (58 cm)
[ ]	OPTI.005048	266394	Mounting for vest
[ ]	OPTI.005083AB	192766	Pelvic belt Acky size 1	(S)
[ ]	OPTI.005083C	192765	Pelvic belt Acky size 2	(M)
[ ]	OPTI.005083D	192764	Pelvic belt Acky size 3	(L)

1) Used only in combination with backrest 2) Used only in combination with backrest hoop

Push Bar

Order	Delivery Art. No.	HMS Art. No.	Push Bar	Illustrations
[ ]	OPTI.000814AB	192904	Push bar bicycle Acky long (requires adapter for push bar)
[ ]	OPTI.210908	192757	Adapter bicycle Acky seat (must be selected in addition to push bar)

Handlebars

Order	Delivery Art. No.	HMS Art. No.	Handlebar
[ ]	SPUI.280174	262252	Standard Handlebar Acky models
[ ]	OPTI.005037A	192917	Bicycle handlebar Acky rectangular
[ ]	OPTI.005121A	192918	Bicycle handlebar Acky rectangular with hydraulic brake
[ ]	OPTI.005120A	192919	Bicycle handlebar Acky individual right

Gear Selector

Order	Delivery Art. No.	HMS Art. No.	Gear Selector
[ ]	AAND.10432	196420	Gear selector ABCD Easy Nexus 7-speed (Grip shift)
[ ]	OPTI.005135	315428	[ ] Gear lever for Nexus grip shift (Additional option for those with poor hand/finger function)
[ ]	OPTI.000925	266380	Gear selector ABCDE Ni/Na Easy thumb/finger buttons

Alternative Throttle Controls

Order	Delivery Art. No.	HMS Art. No.	Alternative Throttle Controls
[ ]	OPTI.001683	266386	Twist throttle half twist
[ ]	OPTI.001685	266388	Twist throttle full twist
[ ]	OPTI.001684	266387	Thumb throttle

Single Hand Brake

Order	Delivery Art. No.	HMS Art. No.	Single Hand Brake	Illustrations
[ ]	OPTI.005069	192773	Brake bicycle Acky/AckyLS combi left
[ ]	OPTI.005070	192774	Brake bicycle Acky/AckyLS combi right

Storage

Order	Delivery Art. No.	HMS Art. No.	Storage
[ ]	205660000S	192763	Luggage box bicycle Acky/ set
[ ]	OPTI.000970	192807	Crutch holder Acky/
[ ]	OPTI.005011A	182810	Basket bicycle Acky/AckyLS front

Miscellaneous Accessories

Order	Delivery Art. No.	HMS Art. No.	Miscellaneous Accessories
[ ]	6989	170012	Tarpaulin TRES bicycle Acky tricycles
[ ]	OPTI.000927	192905	Mirror bicycle Acky
[ ]	OPTI.000928	315622	Mirror Design. Clamp on end of handlebar. Left
[ ]	OPTI.000932	192907	Mirror Design. Clamp on end of handlebar. Right
[ ]	OPTI.005065A	192907	Step bicycle Acky flat
[ ]	PMMS	266356	Hand fixation size S Left
[ ]	PMNS	266359	Hand fixation size S Right
[ ]	STUD.05037		Handlebar socket with hoop, for those with poor grip
[ ]	OPTI.005200	192921	Transport system bicycle Acky
[ ]	NØKKELBATT		Extra key for battery lock (When ordering for an old bicycle, state serial number.)
[ ]	NØKKELLÅS		Extra key for bicycle lock (When ordering for an old bicycle, state serial number.)
[ ]	AAND.13073	266547	Charger (spare part)
[ ]	AAND.130724	256376	Battery (spare part)

SMART BRAKE 1 control

Order	Delivery Art. No.	HMS Art. No.	Description
[ ]	SB101-RBF-TB	297661	SmartBrake for 1 wheel front + 1 tommelbremse
[ ]	SB101-RBF-HC	297662	SmartBrake for 1 wheel front + 1 handbrake
[ ]	SB101-RBF-S	309244	SmartBrake for 1 wheel front + 1 handbrake Slim
[ ]	SB101-RBF-S	297663	SmartBrake for 1 wheel front + 1 rev tommelbr (Switch)
[ ]	SB101-RBF-SLS	309245	SmartBrake for 1 wheel front + 1 rev handebelt Slim (Switch)
[ ]	SB101-RB-BLS	328496	SmartBrake Hybrid for 1 wheel front + 1 handbrake
[ ]	SB101-RB-TB	328497	SmartBrake Hybrid for 1 wheel front + 1 tommelbrems
[ ]	SB101-RB-HC-H	328298	SmartBrake Hybrid for 1 wheel front + 1 Fjernkontroll

SMART BRAKE 2 controller

Order	Delivery Art. No.	HMS Art. No.	Description
[ ]	SB102-RBF-BLS	309255	SmartBrake for 1 wheel front + 2 handebelt Slim
[ ]	SB102-RBF-BLS	309256	SmartBrake for 1 wheel front + 1 hendel Slim + 1 tommel
[ ]	SB102-RBF-TB	297683	SmartBrake for 1 wheel front + 1 hendel Slim + 1 handkont
[ ]	SB102-RBF-TB	297684	SmartBrake for 1 wheel front + 1 tommel + 1 handkont

SMART BRAKE (components)

Delivery Art. No.	HMS Art. No.	Description	Illustrations
MONTSB	N/A	Mounting SmartBrake (if needed)

Components/Parts for SmartBrake Kit:

Fjernkontroll: Art. No: SB-BCH-001
Brakes for thumb/finger: Art. No: SB-BCT-002
Brake handle: Art. No: SB-BCL-001
Brake handle: Art. No: SB-BUH-001
Brake handle Slim: Art. No: SB-BCL-001
USB charger: Art. No: SM3-0003

Tensioner

Delivery Art. No.	HMS Art. No.	Tensioner	Quantity
21		Workmanship
12		Kilometer
19		Bompenger

Backrest and Belt Measurement Diagram

Backrest A

Art. No.	Designation	Size min (cm)	Size max (cm)	Size min (cm)	Size max (cm)
OPTI.005090A Backrest A	OPTI.005090A Backrest B	OPTI.005090B Backrest B	OPTI.005090C Backrest C	OPTI.005090C Backrest D
OPTI.005091AB Belt with buckle	53	66	60	71
OPTI.005091CD Belt with buckle					75
OPTI.005092AB Belt with Velcro	53	67	60	73
OPTI.005092CD Belt with Velcro					75

Backrest without belt

Art. No.	Designation	Length
OPTI.005090A	Backrest without belt 31	25
OPTI.005090B	Backrest without belt 33	28
OPTI.005090C	Backrest without belt 43	35
OPTI.005090D	Backrest without belt 51	43

Adjustable Backrest Hoop

OPTI.005045 Low (42 cm)
OPTI.005046 High (58 cm)

Mounting for Vest

OPTI.005048

Pelvic Belt Acky

OPTI.005083AB Size 1 (S)
OPTI.005083C Size 2 (M)
OPTI.005083D Size 3 (L)

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