| Name | ||
| Address | ||
| City | State | Zip |
| 2008 Trevair Chair Less Wheels | ||
| Clear (brushed aluminum) | ||
| Ferrari Red | ||
| Candy Apple Red | ||
| Championship Orange | ||
| Bright Yellow | ||
| Gloss Black | ||
| Synister (flat) Black | ||
| Beach Boy Blue | ||
| Hot Pink | ||
| Options | ||
| Parking Brake | ||
| Anti-Tip Wheelie Bars | ||
| 3" Roller Blade FrontWheels | ||
| 4" Gray medium soft 3 spoke front wheels | ||
| 4" Roller Blade front wheels | ||
| 4" Roller Blade Lighted front wheels | ||
| Wheels (rear) | ||
| Spinergy std radial spoke main wheels with black wall high press tires, quick pins and clear silver hard anodized hand rims | ||
24" |
||
25" |
||
| Spinergy LITE 12 Spoke "Everyday" main wheels with black wall high press tires, quick pins and clear silver hard anodized hand rims | ||
24" |
||
25" |
||
| 26" Mountain bike main wheels without hand rims, with non-marking "Sweet Skins" knobbies, quick pins and dual mountain bike "Mad Dog" disk brakes | ||
| Shipping | ||
| Anywhere in the U.S. within 4-6 weeks | ||
| Totals | ||
| Total Purchase Price | ||
| Sales Tax (where applicable) | ||
| Grand Total | ||
| 10% Deposit | ||
| Balance due upon shipping | ||
| This wheelchair is not intended for persons unwilling or unable to take respoonsabillity for their own actions | ||
| I hereby understand that the Trevair Chair does not conform to FDA or other goverment regulation standards and has not gone under FDA testing of any kind | ||
| The Trevair Chair was created and designed for the active individual that does not have medical conditions that may require special needs or considerations incorperated into a wheelchair design. If you are unsure of any special chair requirements that may be needed, you must inquire with a qualified physician for a proper evaluation of what wheel chair may be suitable for you. | ||
| Purchaser herewith acknowleges: (a) P.M.W. assumes no liabillity for any misuse of any of its transportation products. (b) Under this liabillity agreement P.M.W. shall have no obligation and the purchaser or user shall have no remedy against P.M.W. , its officers, agents or assigns for any damages including without limitation, incedental, consequntial, special, punitive damages _______ from direct or indirect injury to person or property, or any other loss whether or not occasioned by neglegence or otherwise on the part of P.M.W. (c) Purchaser acknowleges that there is an inerent risk in the operation of mobility devices and P.M.W. transportation products, and herewith assumes the risk of any injury arising from operatio of a P.M.W. transportation product. | ||
| Original owner will imdemnify and hold P.M.W harmless and will take full responsability for conveying all saftey warnings if unit is sold, lent fgifted or otherwise trasnferred to other persons and will imdemnify P.M.W. from any claims against it for original owners fault to do so. | ||
| I hereby state that I am over 18 years of age and have read and understand the above statements. | ||