Electronic Check Secure Payment Processing


      LEE CO FUNDING ACCOUNT HOLDER INFORMATION

      *Account Holders First Name      
      *Account Holders Last Name    
      *Account Holders Account Number               
      *Account Holders Social Security Number    Must Be Entered for Verification
      *Account Holders Regular Monthly Payment      Must Be Entered
      *Amount Being Paid Today                              Must Be Entered
      *Date of Payment                                           Must Be Entered

      CHECKING ACCOUNT HOLDER - INFORMATION:
      * Full Name of Bank                             
      * Checking Account Holders Full Name   
      * Checking Account Holders Address      
      * City     *State     *Zip    
       Apartment Number  or Other Address Information      
       *Checking Account Holders EMAIL    
                                                           

      Checking Account INFORMATION
       * ABA Routing Number          

       * Checking Account Number
     
       * Check Number                    
       * Amount of This Check