2023- 60 Minute Free Session - Be Knot Afraid Financial Coaching

Book your 60 Minute Free Session- Zoom with Kimberley Demarest now.

Duration: 1 hour
Name: *
Email: *
Cell Phone: *
Street Address: *
City: *
State: *
ZIP Code: *
I want you to get the most out of your first coaching session. Below are the questions that help me prepare for your first coaching session. 

This form should take you about 5-10 minutes. It will be longer if you don't know your debt amounts. 

{"type":"text","name":"__generic","width":35,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Name "}

{"type":"text","name":"__generic2","width":10,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Age"}


{"type":"text","name":"__generic3","width":35,"value":"","size":"Normal","validation":"NE","validationMessage":"if you are single, type \"none\" if engaged please list their name. ","placeholder":"Spouse's Name "}

 {"type":"text","name":"__generic4","width":10,"value":"","size":"Normal","validation":"NE","validationMessage":"Type n/a if you don't have a spouse or fiancĂ©. ","placeholder":"Age"}

{"type":"text","name":"__generic5","width":35,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Your Occupation "}

{"type":"text","name":"__generic6","width":35,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item, if you are single please type \"n/a\" ","placeholder":"Spouse's Occupation "}

How did you hear about me? 
{"type":"text","name":"__generic7","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}

Have you taken Dave Ramsey's  Financial Peace University? 
{"type":"radio","name":"__generic8","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Yes\nNo"}

Number of Children under the age of 22?{"type":"text","name":"__generic9","width":15,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. If no children type \"0\" ","placeholder":""}

What is your household monthly net take home pay? $ {"type":"text","name":"__generic10","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. ","placeholder":""}

Do you have irregular income? 
{"type":"radio","name":"__generic11","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Yes\nNo"}

How much do you have in a cash emergency fund? (It is ok to not have an emergency fund yet. ${"type":"text","name":"__generic12","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. ","placeholder":""}

Are you currently investing for retirement? 
{"type":"radio","name":"__generic13","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Yes\nNo"}

What is your monthly contribution? Again it is ok if you haven't started saving yet for retirement. $ {"type":"text","name":"__generic14","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

What is the total amount amount you have saved for retirement? (Approximate amount is ok as well as $0.) $ {"type":"text","name":"__generic15","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Do you rent your own? 
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Rent\nOwn- No Mortgage\nOwn- Have Mortgage\nN/A- I don't own or rent right now."}

What is your total monthly rent/mortgage, it is ok to type $0 if you don't have a mortgage? {"type":"text","name":"__generic17","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Are you current on your rent/mortgage? 
{"type":"radio","name":"__generic18","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Yes\nNo- 1 month behind. \nNo- More than a month behind. \nN/A- Don't have rent or a mortgage."}

Consumer Debt: 

Do you have a vehicle loan or lease?
{"type":"radio","name":"__generic19","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Yes- Loan \nYes- Lease\nNo- Vehicle(s) is/are owned\nNo- I use public transportation"}

What are your total Vehicle Loan/lease payments for all vehicles? It is ok to type $0 if you own your vehicle(s) or take public transportation. $ {"type":"text","name":"__generic20","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

When was the last time you filed your taxes? {"type":"text","name":"__generic","width":50,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}

Total Consumer Debt: 
This section will take you the longest if you don't already have the information. The easiest way to get this information is by getting your annual credit report. You can go to www.annualcreditreport.com and get the report for free. (If you want to know your credit score that will cost.) 

Please type $0 if you don't have debt for a particular category: 

Total Vehicle Loan balance (type $0 if a lease): $ {"type":"text","name":"VD","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Total Credit Card balances $ {"type":"text","name":"CCD","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Total Student Loan balance ${"type":"text","name":"SLD","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Tax debt balance ${"type":"text","name":"TXD","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Other debt balance ${"type":"text","name":"OD","width":25,"value":"","size":"Small","validation":"NE","validationMessage":"Please fill in this item. Ok to type \"$0\" ","placeholder":""}

Total All Debt (This number is calculated for you) $ {"type":"computed","name":"Totaldebt","width":15,"value":"","size":"Normal","validation":null,"validationMessage":null,"formula":"VD+CCD+SLD+TXD+OD","hidden":false}

What are your financial knots? (Please check all that apply) 
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Feel like I/we are just surviving not thriving.\nFinances feel disorganized.\nBudgeting or a Money plan is not working\nDon't have a budget\nNot making progress towards a large financial goal\nToo much debt \nBankruptcy feels like the only option.\nLiving paycheck to paycheck, there is no margin in my/ our finances. \nWant to eat healthier/ live a healthier lifestyle but feel I/we can't afford it. \nWant to tithe to my church but can't seem to fit it in. \nBehind on basic monthly bills. \nWant to feel more in control of my finances.\nWant to spend without feeling guilty and/or stressed. \nWorried about retirement savings. \nFitting in going zero waste\nWant to retire but don't know if I can.\nUnexpected money fights with spouse"}

On a scale of 1 to 10 (10 being the most) how in control to you feel over your money every month? {"type":"text","name":"__generic26","width":10,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}

On a scale of 1 to 10 (10 being the most) how peaceful do you feel over your financial situation?  {"type":"text","name":"__generic27","width":10,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}

On a scale of 1 to 10 (10 being the most) how much guilt/shame do you have over large purchases?  {"type":"text","name":"__generic28","width":10,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}

If married,  on a scale of 1 to 10 (10 being we are totally in synch) how well do you and your spouse communicate about money? 
{"type":"text","name":"__generic29","width":10,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item or type \"n/a\" if single","placeholder":""}

What are 3 things that you would like to achieve by working with a financial coach?
{"type":"text","name":"__generic30","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"1"}

{"type":"text","name":"__generic31","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"2"}

{"type":"text","name":"__generic32","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"3"}

Describe your current methods  or tools you use to plan your monthly budget / money plan? It can be anywhere from an excel sheet, to just checking your daily balance on your bank account. Or you can list that you don't have any tools at all right now. 
{"type":"textarea","name":"__generic33","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

On a scale of 1-10 (10 being perfect) how well is your current method working to achieve your personal financial goals such as debt pay off, saving for retirement or saving for a large purchase? {"type":"text","name":"__generic34","width":10,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}

Scan the QR code or Text the word BUDGET to 734-315-4834  to receive: 
1. A free review of your current budget. 
2. 10% off one to one coaching. 
3. Cash Budgeting Envelopes mailed to you with my unique system for keeping online spending minimized. 

Anything else you would like to share: 
{"type":"textarea","name":"__generic35","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item. or type \"n/a\" if you don't have anything else to share. ","height":80,"placeholder":""}