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Thank You for choosing WheelFlex inc.
Ordering is easy:
We now accept
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| 1. Fill out the order form with the exact measurements
of your chair. Please include the make and model. Already fitting these
chairs: Quantum 610, Invacare, Profile, Quicke, Performance Chair &
Broda Chairs. All other chairs will have to be custom fit. Don’t hesitate
to call if you have any questions. |
| 2. You can also print this form and Fax or Mail
your order form to Wheel Flex inc. |
| 3. We’ll call you to confirm your measurements
and give you an estimated date of delivery. |
For questions or order status, call: 724-216-3605 or
724-787-3059
Fax completed order forms to: 724-834-3257 |
| Mail
Completed forms to: |
Wheel Flex inc.
125 Spanish Villa Drive
Jeannette, PA 15644
724-787-3059
Fax: 724-834-3257 |
Chairs Fit
A. Invacare
B. Profile
C. Quicke
D. Performance Chair
E. Broda Chair
F. Quantum 610 |
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| Invacare |
Quicke |
Broda Chair |
New Wheel Flex RM fits all manual wheel chairs, like the Invacare and Quicke models above.
This new model attaches to the rim of the tire. All non-manual models,
have attachable handrails.
If you don't see your model, e-mail us to confirm whether this will work on your chair. |
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Item
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Quantity
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Make. Model &
Measurements Of Your Chair
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Unit Price
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Total
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| Name:_______________________________________ |
Sub Total:______________ |
| Address:_______________________________________ |
Shipping & Handling:________
(Call for price) |
| Phone#:_______________________________________ |
Sales Tax 6%:_______
(6% applies to PA Residents) |
| E-Mail Address:_________________________________ |
Grand Total:________________ |
Payment Method: |
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| Check (payable to WheelFlex inc.) Credit Card Money
Order Visa MasterCard American
Express
Discover |
| Card#:________________________________________ |
*International Orders Accepted* |
| Expiration Date:_______________________________ |
Please include check or money order if you are not paying by credit card. |
| Signature:x___________________________________ |
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