Order form

Tri-vel inc.
1165, Valet Street
L'Ancienne-Lorette QC G2E 5T5
Telephone:(418) 687-7676
Toll free:(877) 687-7676
Fax:(418) 687-7667

Use the individual to help guide you in taking the necessary measurements to complete this form.

INFORMATIONS

Your email:
Enter your email address and you will receive a copy of this form once it is filled out.

Date:
Weight in lbs:
Foot length with shoes:
Leg (large trochanter to the ground in standing position):	R# L#
Backrest to pedal (wall to heel including the shoe, sitting to ground, back to wall):
Trunk (from the seat to the shoulder in sitting position):
Shoulder (width):
Hip width:
Thorax (width of the back under the shoulders):
Height of the shoulder blades (from the seat to the point of the shoulder blades in a sitting position):
Steering (distance between the shoulder and palm of the hand with 20° at the elbow):
Thickness of the thorax (from the back to the front of the abdomen):
Thickness of the thigh:
Height of the toe piece:
Minimum pedaling (A350):
Maximum pedaling (A350):

Abbreviation
N/A = not applicable	S = small	M = medium	L = large	XL = extra large

Tricycles

Trailers

Color for tricycles and trailers

Stabilizers

Bras de traction

Bikes

Purchasing a bike

Hip backrest

Thoracic backrest

Head rest

Brakes

Special brakes

Brake control

Accompanying brake on bike

Toe clip

Raising block

Peddles

Foot support

Boot heel support

heelpiece height:

Handle

Help in transferring

Reinforced right and left abduction arm

arm length:
circumference of the thigh:

Steering spring

Handlebars

Posts

Seat

Seat covers

Speed

Speed control

Propulsion

Padded crural strap

Prehensile gloves

Breastplates

Delivery

Notes :