Shower Chairs and Bath Lifts
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Shower Chairs and Bath Lifts Thank you for using Invacare eForms. Invacare is pleased to offer you an upgraded solution to your ordering process. Our enhanced order forms allow you to fill out a form electronically, print and fax the form, save and email* it to Customer Service, or maintain the business practices that work for you today. The format has been revised to reveal a cleaner look with electronic selection and input functions. For additional information please visit www.invacare.com/eForms Adobe Acrobat Reader DC * Interactive functions of our new forms work best with the latest version of Adobe Acrobat Reader DC visit https://get.adobe.com/reader/ to download and install on your PC or Mac or visit Google Play/ iTunes to download the Adobe Acrobat Reader DC app for your device. Save Submit Print Adobe Acrobat Reader DC Adobe Acrobat Reader DC If you do not have access to allows you to save this form allows you to submit this Adobe Acrobat Reader DC with your content - to com- form electronically via simply print this form and plete later or use as a start- your email client. complete it by hand and fax ing point for your next form. it to our Customer Service Please note that content Department at: must be added and saved Simply click the submit button below and in Acrobat - saving content from completed forms in the step through the 800-678-4682 browser may not be possible. simple process. SUBMIT CLEAR FORM PRINT FORM PHONE: 800-333-6900 EMAIL: orders@invacare.com FAX: 800-678-4682 MAIL: 1200 Taylor St., Elyria, OH. 44035 FORM NO. 21-125 - 05/24/2021 PAGE 1 of 5
Shower Chairs and Bath Lifts Account Information Request Type: Quote Order Date:______________________________________________ Purchase Order #:___________________________________ Account #:_________________________________________ CONTACT Name:_____________________________________________ Company:__________________________________________ Back Up Contact:____________________________________ SHIP TO Name:_____________________________________________ Phone:_____________________________________________ Address:___________________________________________ Email:_____________________________________________ City:_______________________ State:______ Zip:__________ Comments:_________________________________________ Country:___________________________________________ __________________________________________________ Ocean Ergo Shower Chairs AQUATEC OCEAN ERGO SHOWER & COMMODE CHAIRS OCEANERGO Aquatec Ocean Ergo with Collection Pan, OCEANERGOSPXL Aquatec Ocean Ergo Self Propel Lid, and Pan Support Guide Rail.............................$1,340.00 with Collection Pan, Lid, and Pan Support Guide Rail........ ..............................................................................................$2,300.00 OCEANERGOXL Aquatec Ocean Ergo XL with Collection Pan, Lid, and Pan Support Guide Rail.................. OCEANERGOVIPUS Aquatec Ocean Ergo VIP with ............................................................................................... $1,395.00 Collection Pan, Lid, and Pan Support Guide Rail.................. ............................................................................................. $3,000.00 OCEANERGOSP Aquatec Ocean Ergo Self Propel with Collection Pan, Lid, and Pan Support Guide Rail.................. OCEANERGODUALVIP Aquatec Ocean Ergo Dual VIP ...............................................................................................$1,980.00 with Collection Pan/Lid/Pan Support Rail...... $4,000.00 PHONE: 800-333-6900 EMAIL: orders@invacare.com FAX: 800-678-4682 MAIL: 1200 Taylor St., Elyria, OH. 44035 FORM NO. 21-125 - 05/24/2021 PAGE 2 of 5
Shower Chairs and Bath Lifts ACCESSORIES FOR AQUATEC OCEAN ERGO SHOWER & COMMODE CHAIRS AP1603154 Universal Soft Seat................................... $120.00 10230 Toilet Pan................................................................. $88.00 AP1603142 Standard Soft Seat.................................... $110.00 AP1602078 Toilet Pan Holder........................................ $26.40 AP1603143 Standard Soft Seat Insert........................ $90.20 AP1603992 Front & Back Anti-Tipper (Ergo VIP Models). .................................................................................................... $44.00 AP1603145 Small Soft Seat............................................. $95.00 AP1601986 Front Anti-Tipper (Ocean Ergo Models)........... AP1603152 Small Soft Seat Insert............................... $88.00 ..................................................................................................... $77.00 AP60121311 Ergonomic Special Soft Seat................. $212.19 AP1603606 Comfort Soft Backrest VIP Ergo Models......... .....................................................................................................$70.40 AP1603155 Splash Guard.................................................. $15.40 AP1604136 Comfort Soft Backrest Ocean Ergo Models.... ..................................................................................................... $68.20 1470081 Chest Belt........................................................... $105.60 AP1604016 Comfort Soft Backrest Ocean Ergo XL Models. 1470082 Pelvic Belt.......................................................... $105.60 .............................................................................................................. $70.40 1470077 Armrest Locking Device............................... $110.00 1544469 Variable Soft Seat........................................... $135.03 1558769 Soft Backrest Cushion................................. $100.00 10167-10 Safety Bar............................................................ $80.07 AP1643573 Thigh Support, Right.............................. $319.00 1470078 Safety Bar, XL.................................................... $95.00 AP1643574 Thigh Support, Left................................. $319.00 AP1604015 XL Back.......................................................... $165.85 AP1643543 Calf Support with Foot Support, Right............. 1575299 Fixed Backrest................................................... $26.58 .................................................................................................. $336.00 1470086 Wider XL Armrests......................................... $60.54 AP1643572 Calf Support with Foot Support, Left................ .................................................................................................. $336.00 1531613 Ergonomic Headrest Holder........................ $292.26 16379 24" Self Propel Wheels (Pair)........................ $750.00 1531465 Ergonomic Headrest........................................$103.26 1535077 Lateral Support (Each)................................ $248.60 1531608 Ergonomic Neckrest....................................... $155.74 PHONE: 800-333-6900 EMAIL: orders@invacare.com FAX: 800-678-4682 MAIL: 1200 Taylor St., Elyria, OH. 44035 FORM NO. 21-125 - 05/24/2021 PAGE 3 of 5
Shower Chairs and Bath Lifts ACCESSORIES COMPATIBILITY CHART (See compatibility chart for compatibility of accessories by model) ITEM DESCRIPTION OCEANERGO OCEANERGOSP OCEANERGOXL OCEANERGOSPXL OCEANERGOVIPUS OCEANERGODUALVIP NUMBER Universal Soft Seat AP1603154 Standard Soft Seat AP1603142 Standard Soft Seat AP1603143 Insert Small Soft Seat AP1603145 Small Soft Seat AP1603152 Insert Ergonomic Special AP60121311 Soft Seat Splash Guard AP1603155 Chest Belt 1470081 Pelvic Belt 1470082 Armrest Locking 1470077 Device Soft Backrest 1558769 Cushion Thigh Support, AP1643573 Right Thigh Support, Left AP1643574 Calf Support with Foot Support, Right AP1643543 Calf Support with AP1643572 Foot Support, Left 24” Self Propel 16379 – – Wheels (Pair) Lateral Support 1535077 (Each) Toilet Pan 10230 – – – – – – Toilet Pan Holder AP1602078 – – – – – – Front & Back Anti-Tipper (Ergo AP1603992 VIP Models) Front Anti-Tipper (Ocean Ergo AP1601986 Models) Comfort Soft Backrest VIP Ergo AP1603606 Models Comfort Soft Backrest Ocean AP1604136 Ergo Models Comfort Soft Backrest Ocean AP1604016 Ergo XL Models Variable Soft Seat 1544469 Safety Bar 10167-10 Safety Bar, XL 1470078 XL Back AP1604015 – – Fixed Backrest 1575299 Wider XL Armrests 1470086 Ergonomic 1531613 Headrest Holder Ergonomic 1531465 Headrest Ergonomic 1531608 Neckrest Compatible Not compatible – Included PHONE: 800-333-6900 EMAIL: orders@invacare.com FAX: 800-678-4682 MAIL: 1200 Taylor St., Elyria, OH. 44035 FORM NO. 21-125 - 05/24/2021 PAGE 4 of 5
Shower Chairs and Bath Lifts Bath Lifts AQUATEC BATH LIFTS 1573972 Aquatec R, Reclining Bath Lift- Blue... $2,045.00 1573878 Aquatec SRB, Special Reclining Backrest - White ............................................................................................... $2,178.00 1573877 Aquatec R Reclining Bath Lift- White....................... .............................................................................................. $2,045.00 1574456 Aquatec J, Reclining Bath Lift w/ XL Back for Jacuzzi Style Tubs- Blue........................................... $2,262.00 1573862 Aquatec XL, Reclining Heavy Duty Bath Lift- White.................................................................................... $2,112.00 1574455 Aquatec J, Reclining Bath Lift w/ XL Back for Jacuzzi Style Tubs- White........................................ $2,262.00 AQUATEC BATH LIFTS 4.03.002 Aquatec Transfer Board w/ Rotary Disk- Blue... 15170 Aquatec Height Adapters (set of 4) for Battery ................................................................................................... $176.00 Powered Lifts w/ self-lifting suction cups............... $66.00 4.02.002 Aquatec Rotary Disk Only- Blue............. $140.80 16240AQT Aquatec Extra Large Suction Cups (set of 4) ..................................................................................................... $57.20 1528702 Aquatec Series Padded Adjustable Strap- Chest or Waist.................................................................... $189.20 1525932 Aquatec Pommel (Slip Prevention)- 7 cm.............. .................................................................................................... $139.77 14586AQT Aquatec Bath Lift Carry Bag.................. $110.00 1525933 Aquatec Pommel (Slip Prevention)- 12 cm............. 14694 Aquatec Height Adapters (set of 4) for Battery ................................................................................................... $352.26 Powered Lifts........................................................................ $39.60 3.00.002 Aquatec Step Stool- Blue........................... $135.03 Adobe Acrobat Reader DC * Interactive functions of our new forms work best with the latest version of Adobe Acrobat Reader DC visit https://get.adobe.com/reader/ to download and install on your PC or Mac or visit Google Play/ iTunes to download the Adobe Acrobat Reader DC app for your device. Save Submit Print Adobe Acrobat Reader DC Adobe Acrobat Reader DC If you do not have access to allows you to save this form allows you to submit this Adobe Acrobat Reader DC with your content - to com- form electronically via simply print this form and plete later or use as a start- your email client. complete it by hand and fax ing point for your next form. it to our Customer Service Please note that content Department at: must be added and saved Simply click the submit in Acrobat - saving content button below and from completed forms in the step through the browser may not be possible. simple process. SUBMIT CLEAR FORM PRINT FORM PHONE: 800-333-6900 EMAIL: orders@invacare.com FAX: 800-678-4682 MAIL: 1200 Taylor St., Elyria, OH. 44035 FORM NO. 21-125 - 05/24/2021 PAGE 5 of 5
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