Quote - Active Controls

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What is the make and model of the powerchair you are fitting with Active Controls?
What type of electronics is the chair equipped with? *
What Platform will you be using? (Click on Picture) *

JoyBar
Info

ReJoy
Info

ReJoy 360

Tray Drive
Info

MicroTray
Info

Chin Control
Info

Head Array
Info

Acessories
Info

Modular MicroTray
Info

Swing-Away
Info
What Control System do you need? *

Curtis Joystick

JoyBar

Enhanced JoyBar

MicroPilot
Info Info

MicroGuide
Info Info

Touch Drive 2
Info

Mushroom Drive
Info

4 Proximity Switches

5 Proximity Switches

Q-Logic Attendant Style Joystick

Stealth Head Array

Switch-It Head Array

R-Net Compact Joystick

Active Controls Joystick

Versaguide
Info

ASL Head Array

ASL Micro Extremity Control

ASL Micro Mini Joystick

Stealth Mini Proportional

Custom Needs

Mo-Vis Multi JoyStick

Mo-Vis Micro Joystick

Link Drive, 2 Proximity Switches

Link Drive, Fiber Optics Switches

Head Array Mount - No Head Array

MicroGuide

MicroPilot

Stealth Mini Proportional

Stealth Mushroom Drive

VersaGuide

MoVis Multi

MoVis Micro

Active Joystick

2 Proximity Switches

Fiber Optics

Micropilot

Stealth Mini Proportional Joystick
The control module you selected requires an enhanced display to function. How do you plan to mount the display with the chair?

On the drive control. On the chair's armrest.
We are not aware of any chairs that can have more than 2 lights and actuators on a non-expandable system. Please call 1(800)324-1527 for assistance.
Do you need us to provide you with a display? *

Yes No
Does the powerchair have lights and actuators? *

Yes No
Does the powerchair have more than 2 actuators? *

Yes No
What size are the batteries?

U1 or Smaller Group 22 or Bigger
Would you like to protect it with a Spring/Silicone Ball? *

The MicroPilot is an inductive joystick activated by pressure as apposed to deflection. Because it is fragile, we recommend our silicon ball with spring to protect it durring operation and handling. It also meets FDA requirements for lip mouth control.

Yes - 5/8" Size Ball Yes - 1" Size Ball No
Would you like to include the Chin Kit? *

The Chin Kit is made up of two 'whiskers' - one side is a switch for On/Off, the other is a switch for mode. Also included is a foam ball for interfacing with the chin drive control.

Yes No
Where will you mount the socket(s)? *

Rear Side Front
Number of Sockets
Front Socket Bracket *

Flip Down
7.5” long, angle adjusts w/allen wrench, button flips down

Fixed - Angle Adjustable
5.25” long, adjusts w/allen wrench

Fixed - Flat
5.7” long

Front 2-Piece Combo Bracket - 30295
Height & Angle Adjustable (Removeable)

Fixed - 10° Bend
5.7” long with 10° slight angle
Would you like to add a 12x12” Evaluation Plate for the front socket? *

The front socket requires the installation of a socket bracket to the chair. The Evaluation Plate allows you to quickly and easily setup a front socket without any modifications to the seatbase. The Evaluation Plate is attached with velcro backing for easy on/off removal of the front socket.

Yes No
Side Socket Bracket *

Fixed - Angle Adjustable
8.25” long, adjusts w/allen wrench

Fixed - Flat
5.7” long

Fixed - 10° Bend
5.7” long with 10° slight angle

Fixed - Angle Adjustable
5.25” long, adjusts w/allen wrench
Rear Socket Bracket *

Fixed - Angle Adjustable
For Attendant, 12” long, adjusts w/allen wrench

Tubular Attendant Socket Bracket
Attendant socket bracket for rear square accessory tube

Head Array Socket Bracket
Accessory

Info

Recharge
Charger Adaptor for users who can not plug in their XLR charger plug
Info

Recharge+
Includes Charge-Only Socket with XLR plug to connect to existing charge port
Info

Active Tray
Articulating Activity Tray - Only for use w/Center Drive System

Active Tray+
Includes non-powered holster socket
Info

PowerBuddy
USB Charger & Guide Light (single unit)

PowerBuddy Case of 8
Minimum Order Quantity (if not ordered with a system)

PowerBuddy Carton of 40
USB Charger & Guide Light (Carton of 40)

PowerPouch Armrest Bag
To store items while PowerBuddy charges them

PowerPouch Case of 8
(Minimum Order Quantity)

Power Buddy + Power Pouch Case of 8

Info

Airsafe
For safer transportation of mobility vehicles

Holster Socket
For storing drive control when not-in-use (includes bracket)
Contact Name *
Company Name
Phone Number
E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Ship the controls preassembled on a Pride Powerchair? *

Yes No
Please order the powerchair from Pride/Quantum and request for it to be shipped to:

Active Controls
597 Mantua Blvd.
Sewell, NJ 08080
I either already have a powerchair at my location that I will install Active Controls on, or I am going to order the powerchair to ship to my location and will perform the installation myself.
Is the quote you are requesting for a Veteran / VAMC? *

Yes No
Please Enter the Last Name and Last 4 Digits of the veteran's social for future identification. *

Active Controls Account #

Mark For:

I do not know my account # I am a new provider
Additional Comments
Part Numbers
Should be Empty: