Pride Mobility Baja Bandit Order Form Owner's manual

Brand: Pride Mobility

Model: Baja Bandit Order Form

Type: Owner's manual

Page 1 of 2INFINFB4535/RevA/17AUG2023

BAJA® Bandit ................................................................... $3,999

Part: BA140. HCPCS: K0899 — Power mobility device,

not coded by DME PDAC.

BAJA® Bandit Scooter — Quick Ship Order Form

INTRODUCTION

This form is interactive when viewed in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat.

HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining

the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are

MSRP. Prices, specications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available

when congured as a complete scooter. Pride Providers may contact Technical Service for accurate parts ordering.

Thank you for choosing Pride® Mobility Products!

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City:_________________ Prov:______ Postal:__________

MODEL

REQUIRED. Weight capacity: 400 lbs. Find more specications at pridemobility.com/bajabandit.

Standard Features

• 36V 20Ah lithium batteries

• 4-amp o-board charger

• Front basket

• Full light package

• Full bumper package

• Innite tiller adjustment lever

• Feather-touch disassembly

• Supplemental brake

• Stadium seat with memory foam

• Integrated USB charger

• Integrated XLR charging port

COLOR

REQUIRED. Colors shown here may dier from actual product depending on monitor/printer calibration.

SEATING

REQUIRED. Select one seat.

Stadium Seat

Optional Seating

Pride® Mobility Products Corporation

401 York Ave., Duryea, PA 18642

Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: prideorders@pridemobility.com

Tan

Part: DGN2203901

Sage

Part: DGN2207330

Foldable Deluxe Stadium Seat with Sliders, 18″W × 17″D ........................................................................................................Standard

Part: SET2002307

Compact Foldable Seat, 20″W × 18″D ................................................................................................................................................ $100

Part: SET1909617

Tan Sage

FDA Class II Medical Device*

*Pride® Scooters are FDA Class II Medical Devices designed to aid individuals with mobility impairments.

Page 2 of 2INFINFB4535/RevA/17AUG2023

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CANE/CRUTCH HOLDER

Optional. Only one cane/crutch holder can be used at a time.

Wishbone Crutch Holder .............. $98

Part: FRMASMB2358

Quad Cane Holder ......................... $98

Part: ACCASMB1931

Forearm Crutch Holder ................. $98

Part: ACCASMB1019

Single Rear Mount, 3″.................... $70

Part: ACCINDV1058

Double Rear Mount, 3″ .................. $70

Part: ACCINDV1019

BRANCH PATCHES

Optional.

Air Force Patch ............................... $21

Part: ACC140240

Army Patch ..................................... $21

Part: ACC140241

Coast Guard Patch ........................ $21

Part: ACC140239

Marines Patch ................................. $21

Part: ACC140243

Navy Patch ...................................... $21

Part: ACC140244

Purple Heart Patch ........................ $21

Part: ACC140238

LAP BELTS

Optional.

50″ Lap Belt ...............................$39.90

Part: ACCBELT1000

60″ Lap Belt ............................... $39.90

Part: ACCBELT1002

70″ Lap Belt ................................ $39.90

Part: ACCBELT1003

Pride® Mobility Products Corporation

401 York Ave., Duryea, PA 18642

Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: prideorders@pridemobility.com

Rear Basket (15 . 2 5 ″ × 9 . 7 5″ × 9 . 5″ ) ..$95

Part: ACCBSKT1010

Oxygen Tank Holder ...................... $98

Part: ACCASMB1017

Walker Holder ............................... $103

Part: ACCASMB1018

BACK-MOUNTED ACCESSORIES

Optional. Only one back-mounted accessory can be used at a time. Includes mounting bracket and hardware.

ACCESSORIES

Optional.

Medium Weather Cover ............... $158

Part: ACCCOVR1019

Cup Holder, Style C ....................... $32

Part: ACCASMB2288

Used with SET2002307

Cup Holder, Style D ....................... $42

Part: ACC120041

Used with SET1909617

Cell Phone Holder .......................... $70

Part: ACC1804467

Rearview Mirror .............................. $35

Part: LGTRMIR1003

Saddle Bag (12.5″ × 9.875″) ............ $40

Part: DWR1020D010

Safety Flag ...................................... $38

Part: ACCFLAG1000

Accessories Kit ............................ $140

Part: KIT2102055

Includes C-Style Cup Holder, Rear Basket,

and Saddle Bag

Accessories Kit ............................ $140

Part: KIT2102066

Includes D-Style Cup Holder, Rear Basket,

and Saddle Bag

BATTERIES

REQUIRED. Select one option below.

Battery, 36V 20Ah Lithium ........................................ Standard

Part: BAT2204152

Battery, 36V 40Ah Lithium ................................................ $800

Part: BAT2204150

Pride Mobility Baja Bandit Order Form Owner's manual

Brand: Pride Mobility

Model: Baja Bandit Order Form

Type: Owner's manual

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Pride Mobility Baja Bandit Order Form Owner's manual

Pride Mobility Baja Bandit Order Form Owner's manual

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