Order Request Summary Quote Number: A552826-0

Order Date: 5/15/2023

Sales Rep: 8403
Customer Number: D0073
5201 Woodward Drive PO Number: OP#155-DISMED
Stevens Point, WI 54481 Marked For: GEIMAN DANILO
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
SPARK Spark (E1238) $3,177.00 $1,906.20 $1,277.15
*Less Discount if paid within terms $3,177.00 $1,906.20 $1,277.15
Shipping & Handling $48.00
Total $1,325.15

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 Order Request Details Quote Number: A552826-0
Order Date: 5/15/2023
Sales Rep: 8403
Customer Number: D0073
5201 Woodward Drive PO Number: OP#155-DISMED
Stevens Point, WI 54481 Marked For: GEIMAN DANILO
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
SPARK Spark (E1238) 1
SPOPTTRN Spark Frame: Spark - Transit Not Included $2,100.00 $1,260.00 33.0% $844.20
(E1238)
SPSWT016 Seat Width: 16"
SPSDE016 Seat Depth: 16"
SPTRNOP2 Transit Option: Omit Transit
SPACC004 Seat Pan: Removable Aluminum Seat Pan (1/2" $283.00 $169.80 33.0% $113.77
Shorter than Depth) (E2231)
SPBOP033 Backrest: Height Adjustable Straight with Push $77.00 $46.20 33.0% $30.95
Handle (Depth Adjustable)
SPBRH220 Backrest Height: 22"
SPBHE004 Backrest Height: Tall
SPFRM001 Frame Type: Swing Away
SPHAN004 Footrest Hanger Type: 90° Front Mount
SPFML002 Front Mount Hanger Length: Medium Front Mount
Hanger
SPFL130 Seat to Footrest Length: 13"
SPEXT008 Hanger Extension Tubes: 3" Extension $57.00 $34.20 33.0% $22.91
SPFPL002 Footplates: Aluminum Angle Adjustable (K0040) $170.00 $102.00 33.0% $68.34
SPREL002 Hanger Release: 4-Way - In-Line
SPACC008 Heel Loops: Heel Loops (E0951)
SPFS200 Front Seat Height: 20"
SPCAS010 Casters: 5" x 1" Poly
SPCST003 Caster Options: 1 1/2" Longer Fork Stem
SPCSH001 Caster Options: Standard Housing
SPWLK003 Wheel locks: Pull to Lock
SPRS190 Rear Seat Height: 19"
SPAXP009 Axle Plates: Universal
SPWH1224 Wheels: 24" MAXX Mag - Black
SPHRM001 Handrims: Aluminum Anodized
SPTAB002 Handrim Options: Long Tabs (Standard Mount)
SPTIR001 Rear Tire Type: Street Pneumatic 1 3/8" $52.00 $31.20 33.0% $20.90
(E2211, E2212)
SPAXO003 Axles: Quick Release
SPWC00 Rear Wheel Camber: 0°
SPCOG002 Center of Gravity Preset: Center
SPARM003 Armrests: Height Adjustable T-Arm Desk (8.5" - $294.00 $176.40 33.0% $118.19
13.5") (E0973)
SPARM026 Arm Pads: Standard Arm Pad
SPATP001 Anti-Tips: Rear Anti-Tips (E0971) $144.00 $86.40 33.0% $57.89
SPFCS032 Frame Color: Metallic Orange

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