Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Forgot Password?
Get Started
OR
Sign UpLogin With Facebook
Sign UpLogin With Google

Mileage Reimbursement Form Template

Easily Manage Employee Travel Expenses

Managing employee travel expenses can be a hassle, but it doesn't have to be. This Mileage Reimbursement Form Template helps businesses efficiently process reimbursements, ensuring your team is compensated fairly for their travel. Utilize this template to save time, maintain accurate records, and simplify expense tracking, all while ensuring compliance with reimbursement policies. Plus, this WCAG-aligned form template is ready for use right away, so you can get started without delay.

Use this Template (FREE) Live Preview
Full name of claimant
Work email
Employee ID or reference
Department or team
Cost center or project code
Claim period start date
Claim period end date
Primary business purpose for this travel
Was a company vehicle used for any part of this travel?
Yes
No
Total business distance for this claim (enter number only)
Reimbursement rate per unit (e.g., 0.655 USD per mile)
Calculated mileage amount to reimburse (currency + amount)
Parking and tolls amount to include (currency + amount)
Other eligible travel expenses to include (optional, currency + amount)
Trip log summary (include dates, origins, destinations, and business purpose for each trip)
Unit used for distance
Miles
Kilometers
Were any personal or commuting miles included and excluded from the totals?
Yes
No
If yes, enter the estimated personal/commuting miles excluded (enter number only)
Type your full name as your signature
Signature date
I certify the information provided is accurate, business-related, and not previously reimbursed
Yes
No
Approver full name
Approval date
Approver comments (optional)
Approval decision
Approved
Needs more information
Declined
Payee name (if different from claimant)
Mailing address for check (only if requesting check)
Preferred reimbursement method
Payroll
Bank transfer
Check
No preference
Other
Please Specify:
{"name":"Full name of claimant", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name of claimant, Work email, Employee ID or reference","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration featuring a mileage reimbursement form with design elements related to finance and travel

When to use this form

Use this form when your team drives their own car for work and needs to be paid back for miles. It fits sales reps logging client visits, field staff moving between sites, home-care aides, and volunteers using personal vehicles. Capture start and end points, purpose, odometer readings, and rate to calculate totals and speed approvals. Managers get a consistent record; finance gets clean data for payroll or expense runs. If trips also include tolls or parking, pair it with the Travel expenses form. For tax-compliant payouts under an accountable plan, add the Accountable plan reimbursement form. To track small cash disbursements alongside mileage, keep a running log in your Money tracker form.

Must Ask Mileage Reimbursement Questions

  1. What was the date of each trip?

    Dates tie the claim to the right pay period and mileage rate. They also help managers match trips to calendars or job tickets.

  2. Where did you start and end each trip?

    Start and end locations let you verify distance and exclude personal or commute miles. This reduces disputes and speeds approval.

  3. What was the business purpose?

    A clear purpose proves the travel was for business, which is required for audit and tax rules. It also helps apply the right policy or cost center.

  4. How many business miles did you drive (or odometer start and end)?

    Miles or odometer readings are the core numbers used to calculate the reimbursement. Asking for both options reduces guesswork and avoids math errors.

  5. How should we pay you for this claim?

    Stating your payment method (payroll, ACH, or cash) avoids back-and-forth and sets expectations on timing. If you use cash payouts, process them with the Cash claim form so finance can reconcile fast.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel