Skip to content
Home
About Sewa
Our Products
MIRAI SERIES
MIRAI LTR
MIRAI LT
MIRAI LR
MIRAI TR
MIRAI T
MIRAI R
PREVISION
FUTURE PLAYER
FUTURE Ex
FUTURE L
Rider
Accessories
Customization
Contact Us
Menu
Home
About Sewa
Our Products
MIRAI SERIES
MIRAI LTR
MIRAI LT
MIRAI LR
MIRAI TR
MIRAI T
MIRAI R
PREVISION
FUTURE PLAYER
FUTURE Ex
FUTURE L
Rider
Accessories
Customization
Contact Us
Order Form
Home
About Sewa
Our Products
MIRAI SERIES
MIRAI LTR
MIRAI LT
MIRAI LR
MIRAI TR
MIRAI T
MIRAI R
PREVISION
FUTURE PLAYER
FUTURE Ex
FUTURE L
Rider
Accessories
Customization
Contact Us
Menu
Home
About Sewa
Our Products
MIRAI SERIES
MIRAI LTR
MIRAI LT
MIRAI LR
MIRAI TR
MIRAI T
MIRAI R
PREVISION
FUTURE PLAYER
FUTURE Ex
FUTURE L
Rider
Accessories
Customization
Contact Us
SERIAL NO.
JOB NO.
RECEPTION NO.
Name
(Required)
First
Last
Date
MM slash DD slash YYYY
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
City
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
CHOOSE MODEL OF THE WHEELCHAIR
MIRAI T
MIRAI TR
MIRAI LR
MIRAI LT
MIRAI LTR
MIRAI R
RIDER
FUTURE L
FUTURE R
FUTURE EX
PREVISION
CHOOSE COLOR FOR WHEELCHAIR
WHITE
SILVER
PURPLE
RED
PINK
GREEN
BLUE
ORANGE
CUSTOM
CUSTOM COLOR (Colour Code or Color Name)
CHOOSE SEAT WIDTH(MM):
400 (STANDARD)
380
430
450
CUSTOM
EAT DEPTH(MM)
(Required)
400 (STANDARD)
380
430
450
CUSTOM
Custom SEAT WIDTH (MM)
EAT DEPTH CUSTOM (MM)
BACK REST HEIGHT
560
CUSTOM
JOYSTICK POSITION
LEFT
RIGHT
JOYSTICK HEIGHT
NORMAL
LOW
Custom BACK REST HEIGHT (MM)
QUAD LINK
YES
NO
ARM REST
SHORT
LONG
CUSTOM
CASTERS
NORMAL
5 INCH
HB CASTER
CUSTOM
ARM REST
CUSTOM CASTERS
FOOT REST
FIXED
LONG ELEVATION
SHORT ELEVATION
CUSTOM
BATTERY
36AH
50AH
CUSTOM
POSITION
245
260
275
290
CUSTOM
FOOT REST
BATTRY (AH)
CUSTOM POSITION
SIDE GUARD
Yes
No
TIRE
AIR
REPAIRM GEL
NON PUNK
DRIVE ELECTRONICS
VR2
R-NET
DRIVE SYSTEM
FRONT WHEEL DRIVE
MIDDLE WHEEL DRIVE
REAR WHEEL DRIVE
HEAD REST SIZE
SMALL
LARGE
CUSTOM
SEAT CUSHION (MM)
MOORLESS CUSHION EITH SEGMENTS
CUSTOM
HEAD REST SIZE (CUSTOM)
CUSTOM SEAT CUSHION (MM)
SIZE(WXH)
400 * 400
400 * 430
CUSTOM
BACK CUSHION (WXH)
400*500
CUSTOM
CUSHION COLOR (SIDE ONLY)
BLACK
PURPLE
LIGHT BLUE
GREEN
GREY
NAVY
RED
CUSTOM
CALF PAD
STANDARD
NONE
CUSTOM
CUSTOM SIZE(WXH)
CUSTOM BACK CUSHION (WXH)
CUSTOM CUSHION COLOR (SIDE ONLY)
CUSTOM CALF PAD
Remarks
