LT Tilt Chair CDN MSRP Order Form March 2016 PO#:___________________ Order Date:_________________ Customer #:________________ Customer Name: Address: Phone: Contact: Email: Ship to: Address: Phone: Contact: Tag: LT Tilt Chair $1495 Standard Features: Seat Width: Seat Depth: Back Height:  19”  18”  32” Frame Colour:  Chestnut Brown Strap Colour:  Chestnut Brown Padding Colour: Padding Options:  Meteor  Full Wrap Vinyl Covers (factory installed)  Seat pad with V‐Notch Quantity: (for thigh belt) (not available with full wrap vinyl covers) Positioning Devices:  NR‐C ‐ Neckrest Contoured Pad  NR‐CV ‐ Neckrest Visco Foam Contoured Pad  SR ‐ Side Reduction Pads (PR)  S‐BELT ‐ Seat Belt  T‐BELT ‐ Thigh Belt  T‐BELT‐NEO ‐ Thigh Belt ‐ Neoprene • • • • • • BRODA Comfort Tension Seating® 16 Gauge Powder Coated Tubular Steel 28° Infinitely Adjustable Seat Tilt Infinitely Adjustable Elevating Legrest Soft, Durable Polyurethane Armrests 3 x 5” Total Lock Casters, 1 x 5” Rear Directional Lock Caster • 26” Overall Width • 65lbs Overall Weight • 300lb Weight Capacity Standard Removable Vinyl Padding: • Vinyl Seat and Back Pads N/C • Neckrest Pad • Side Panels N/C • Legrest Pad $100 $100 $95 $50 $115 $115 Other:  IV‐POLE  O2 HOLDER Delivery Instructions or Special Requests: *thigh belts only available with v‐notch seat pad IV Pole & Holder (black) O2 Holder (black) $95 $95 Total: $ BRODA Seating PHONE: 1‐844‐552‐7632 FAX: 1‐844‐442‐7632 EMAIL: customerservice@brodaseating.com WEBSITE: www.brodaseating.com Pricing and Specifications are subject to change without notice. Taxes where applicable. Page 1 of 1 PSOF 02‐ORDER‐025 MAR16 
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