One Month Funded Trial AgreementFunded Trial Agreement • August 28th, 2020
☐ I-13 Please Select Mount☐ Table Top☐ Floor Stand ☐ I-16 Please Select Mount☐ Table Top☐ Floor Stand ☐ I-110 Keyguards Mount Options ☐ Table Top☐ Floor Stand☐ Wheelchair* *Only one mount can be supplied Head Tracking ☐ Indi 7☐ SC Tablet ☐ SCF 2x2☐ SCF 3x3 ☐ C5 4x3☐ C5 6x4 ☐ Headmouse☐ TrackerPro ☐ SCF 4x4 ☐ C5 7x5 Switches ☐ SCF 5x5☐ SCF 6x6 ☐ C5 8x5☐ C5 8x6 ☐ Buddy Button☐ Microlight If selecting a Wheelchair Mount, please also select a fastener: ☐ Round Tube ☐ Side ClampIf you are not sure which Chair Fastener is needed, please specify wheel chair make and model: ☐ Channel Nut ☐ Permobil
One Month Funded Trial AgreementFunded Trial Agreement • November 26th, 2014
I-12I-12 with Eye Gaze Please Select MountTable Top Floor Stand I-15I-15 with Eye Gaze Please Select MountTable Top Floor Stand I-110KeyguardsSnap + Core First3 x 34 x 45 x 56 x 67 x 7 Communicator 54 x 36 x 47 x 58 x 58 x 6 IndiKeyguardsSnap + Core First3 x 34 x 45 x 56 x 67 x 7 Indi 7KeyguardsSnap + Core First3 x 34 x 45 x 56 x 67 x 7 Mount OptionsTable Top Mount Floor Stand Mount Wheel Chair Mount Select Chair Fastener**Only needed for wheelchair mounts Round – 1” or 7/8” tube Side Clamp – 1” Channel NutPermobilOther (please specify chair make and model) AccessoriesBuddy Button- No Cost Microlight Switch- No Cost
One Month Funded Trial AgreementFunded Trial Agreement • November 26th, 2014
☐ I-13 Please Select Mount☐ Table Top☐ Floor Stand ☐ I-16 Please Select Mount☐ Table Top☐ Floor Stand ☐ I-110 Keyguards☐ Indi 7☐ SC Tablet ☐ SCF 2x2 ☐ C5 4x3☐ SCF 3x3 ☐ C5 6x4☐ SCF 4x4 ☐ C5 7x5☐ SCF 5x5 ☐ C5 8x5☐ SCF 6x6 ☐ C5 8x6 Mount Options ☐ Table Top☐ Floor Stand☐ Wheelchair* *Only one mount can be supplied Head Tracking☐ Headmouse☐ TrackerPro Switches☐ Buddy Button☐ Microlight If selecting a Wheelchair Mount, please also select a fastener: ☐ Round Tube ☐ Side ClampIf you are not sure which Chair Fastener is needed, please specify wheel chair make and model: ☐ Channel Nut ☐ Permobil
