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INFINFB3877/RevC/23SEP2020
VivaLIFT!
®
Power Recliner Order Form
Pride
®
Mobility Products Corp.
401 York Ave., Duryea, PA 18642
Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: prideorders@pridemobility.com
Account Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _______________ Marked for: ____________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
This form is interactive when viewed with 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, specications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available
when congured as a complete power lift recliner. Pride Providers may contact Technical Services for accurate parts ordering.
Thank you for choosing Pride
®
Mobility Products!
VivaLIFT!
®
MODELS
FDA Class II Medical Device* | Select model and fabric color below. (See Pages 2 and 3 for more models.) Weight capacity: 400 lbs.
INTRODUCTION
Elegance ............................................................................................................................................................... $1,699
Part: PLR-975M HCPCS: E0627 — seat lift mechanism, electric, any type.
Walnut ........... Standard
Part: FABVBW
Badlands Fabrics:
Mushroom ....Standard
Part: FABVBM
Steel ..............Standard
Part: FABVBL
Elegance ............................................................................................................................................................... $1,849
Part: PLR-975L HCPCS: E0627 — seat lift mechanism, electric, any type.
Walnut ........... Standard
Part: FABVBW
Badlands Fabrics: Mushroom ....Standard
Part: FABVBM
Steel ..............Standard
Part: FABVBL
Gunmetal ......Standard
Part: FABVSG
Granite ..........Standard
Part: FABVSR
Urbana ................................................................................................................................................................... $1,699
Part: PLR-965M HCPCS: E0627 — seat lift mechanism, electric, any type.
Stonewash Fabrics:
Mossy............ Standard
Part: FABVSM
Mushroom ....Standard
Part: FABVBM
Atlas ....................................................................................................................................................................... $1,999
Part: PLR-985M HCPCS: E0627 — seat lift mechanism, electric, any type.
Badlands Fabrics:
Steel ..............Standard
Part: FABVBL
Walnut ...........Standard
Part: FABVBW
Atlas Plus
1
with Wireless Charger
2
................................................................................................................... $1,999
Part: PLR-2985M HCPCS: E0627 — seat lift mechanism, electric, any type.
Badlands Fabrics: Walnut ...........Standard
Part: FABVBW
Steel ..............Standard
Part: FABVBL
Mushroom ....Standard
Part: FABVBM
1
Atlas Plus is available exclusively to authorized Pride
®
brick-and-mortar providers. No Internet sales or advertising of the Atlas Plus. Other
conditions apply.
2
The wireless charger is only compatible with smartphones that have wireless charging capabilities. Additionally, no other smart devices
(e.g., smartwatches) should be used with the wireless charger.