VMS - Virtual Mounting Solutions

VMS Application Form

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REQUESTOR


CLIENT



Optional - specify the Rehadapt reseller to handle this matter:


WHEELCHAIR





DEVICE






iPad users - please specify the model exactly (e.g. „iPad Air 2“). If unsure, please write the Model No. („A1XXX“ printed on the back of the iPad).

Do you want the iPad to be mounted within an Otterbox Defender Case? (Due to the plethora of different cases, we can not ensure that other fit well)


Please specify brand, model and exact dimensions (Height x Width x Depth)


Mount side (in direction of user):


Handles for toolless adjustment:


Any additional mounting requirements (e.g. 2nd wheelchair, Floorstand, TableTop) or notes?


PICTURE UPLOAD


Very Important - take pictures of the wheelchair in the listed viewing angles shot from a straight low angle. Please make sure they depict the wheelchair clearly, in proper light conditions and with correct focus. Make sure to include device or facsimile at the desired position (It’s okay to use a dummy, like a sheet of paper)! Send this information to vms@rehadapt.com


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