Order Request Summary Quote Number: A550238-0

Order Date: 5/08/2023

Sales Rep: 8403
Customer Number: D0073
5201 Woodward Drive PO Number: OP#154-DISMED
Stevens Point, WI 54481 Marked For: JHON JADER JANC
ATP/RTS: Juan Carlos
Phone: (800) 981-1540 Payment Term: Wire Transfer
Fax: (715) 254-0996

Bill to: Distribuciones Medico Hospitalarias SasDistribucionesShip

Medico
to: Distribuciones
Hospital Medico Hospitalarias Sas
Carrera 40 A N 16D -108 Carrera 40 A N 16D -108
Barrio El Dorado Barrio El Dorado
Pasto, COL Pasto, COL
Contact: JUAN CARLOS SANABRIA
Phone: 3225471099
Email: componentesdismed@gmail.com
Fax:

Item No. Description Retail Primary Secondary*

Price Price Price
FLIP XP Little Wave Flip XP $3,830.00 $2,298.00 $1,336.69
*Less Discount if paid within terms $3,830.00 $2,298.00 $1,336.69
Shipping & Handling $48.00
Total $1,384.69

Page 1 of 2
 Order Request Details Quote Number: A550238-0
Order Date: 5/08/2023
Sales Rep: 8403
Customer Number: D0073
5201 Woodward Drive PO Number: OP#154-DISMED
Stevens Point, WI 54481 Marked For: JHON JADER JANC
ATP/RTS: Juan Carlos
Phone: (800) 981-1540 Payment Term: Wire Transfer
Fax: (715) 254-0996

Bill to: Distribuciones Medico Hospitalarias SasDistribucionesShip

Medico
to: Distribuciones
Hospital Medico Hospitalarias Sas
Carrera 40 A N 16D -108 Carrera 40 A N 16D -108
Barrio El Dorado Barrio El Dorado
Pasto, COL Pasto, COL
Contact: JUAN CARLOS SANABRIA
Phone: 3225471099
Email: componentesdismed@gmail.com
Fax:

Item No. Description Qty Retail Primary Secondary*

Price Price Disc % Price
FLIP XP Little Wave Flip XP 1
PTFLD Flip Frame: Flip - Folding Base (E1234,E1161) $2,980.00 $1,788.00 44.35% $995.00
PTSWT010 Frame Width: 10"
PTFDE012 Frame Depth: 12"
PTFDR004 Frame Depth Range: Short (12" - 16")
PTTRNOP2 Frame Options: Omit Transit
PTTLT004 Tilt Mechanism: Foot Tilt
PTACC004 Seat Option: Growing Solid Seat Pan (E2231) $175.00 $105.00 33.0% $70.35
PTBOP018 Backrest: Adjustable Height Back with
Adjustable Handle (Short 18" - 25")
PTBRH180 Backrest: 18" Back Height
PTBCK001 Back Options: Adjustable Height Rigidizer Bar $77.00 $46.20 33.0% $30.95
PTHAN004 Footrest Hanger Type: 90° Front Mount
PTFML002 Front Mount Hanger Length: Medium Front Mount
Hanger
PTFL065 Seat to Footrest Length: 6.5"
PTEXT007 Hanger Extension Tubes: Omit 3" Extension
PTFPL002 Footplates: Aluminum Angle Adjustable (K0040) $170.00 $102.00 33.0% $68.34
PTREL002 Hanger Release: 4-Way - In-Line
PTACC011 Heel Loops: Omit Heel Loops
PTFS160 Front Seat Height: 16"
PTCAS014 Casters: 6" x 1" Poly
PTAXO003 Axles: Quick Release
PTAXP001 Axle Plates: Standard
PTWHE116 Wheels: 16" Mag $52.00 $31.20 33.0% $20.90
PTTIR002 Rear Tire Type: Full Poly (E2218)
PTWLK011 Wheel locks: Attendant Foot Lock
PTARM014 Armrests: Height Adjustable Pediatric Desk $232.00 $139.20 33.0% $93.26
(6.5" - 9")
PTARM026 Arm Pads: Standard Arm Pad
PTATP001 Anti-Tips: Rear Anti-Tips (E0971) $144.00 $86.40 33.0% $57.89
PTFCS029 Frame Color: Yellow
PTFAC029 Frame Color: Yellow Accent

Page 2 of 2