PARTICIPANT DISTRIBUTION ELECTION

To the Advisory Committee of the Chancellor & Chancellor, Inc. 401(k) Plan ("Plan").

Re: ________________________________________, Participant.

1. Election. I, the undersigned Participant, have read the "Notice to Participant of Distribution Election" and the "Special Tax Notice Regarding Plan Payments" and make the following distribution election: (Choose (a), (b), (c) or (d) )

(   )      (a) A direct rollover of my entire Vested Account Balance to the IRA or plan designated in Section 2.

(   )      (b) A direct rollover of the following portion of my Vested Account Balance to the IRA or plan designated in Section 2: _________________ (not less than $500), with the balance remaining in the Chancellor & Chancellor, Inc 401(k) plan.

2. Information for Direct Rollover. [Do not complete unless you check 1.(a) or 1.(b)]

I represent the IRA or plan designated below is a proper recipient plan for a direct rollover.

Name of IRA or plan ___________________________________________________________

If an IRA, name of trustee, custodian or insurer ______________________________________

___________________________________________________________________________

Address to send direct rollover ___________________________________________________

___________________________________________________________________________

3. Execution. Dated this ___________ day of _____________________, 19 _____.

Your Signature _________________________________________

Your Social Security Number ______________________________

Your Address __________________________________________

(You may print out this page from your browser or cut & paste into a word processor, fill in your information, & e-mail or fax us the completed form. E-mail: anthony(at)chancellor(dot)com.)