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ATC Wheelchair Quantifier Sheet - [your-name]
[_site_title]
sales@atc-distributors.com
User Details
________________________________
Name: [your-name]
Phone: [your-phone]
Email: [your-email]
Dealer: [your-dealername]
Sales Rep: [your-salesperson]
User Weight: [your-userweight]
User Height: [your-userheight]
Vehicle
________________________________
[your-vehicleyear] [your-vehicledrivetrain] [your-vehiclemake] [your-vehiclemodel]
Cabstyle: [your-cabstyle]
Fuel Type: [your-fueltype]
Center Console Type: [your-centerconsole]
Sunroof: [your-sunroof]
Desired conversion side: [your-desiredconversionside]
Power Chair Details:
________________________________
A - Overall Width: [your-a-overallwidth]
B - Overall Length: [your-b-overalllength]
C - Footrest Width: [your-c-footrestwidth]
D - Overall Height: [your-d-overallheight]
E - Sightline to Floor: [your-e-sightlinetofloor]
F - Largest Wheel Diameter: [your-f-largestwheeldiameter]
G - Wheel Axle to Center Steering Wheel: [your-g-wheelaxletocentersteeringwheel]
H - Footrest Height: [your-h-footrestheight]
I - Knee Height: [your-i-kneeheight]
J - Footrest Offset: [your-j-footrestoffset]
K - Front Tire Width: [your-k-fronttirewidth]
L - Chest to Steering Wheel: [your-l-chesttosteeringwheel]
M - Top of Legs to Sightline: [your-m-topoflegstosightline]
N - Back to Front of Toes: [your-n-backtofrontoftoes]
Additional Comments
________________________________
[additional-comments]
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