Mileage Reimbursement Form Template

This Mileage Reimbursement Form Template allows you to collect mileage reimbursement requests in a clear and structured way.

The template includes common mileage reimbursement fields such as travel dates, distance traveled, purpose of the trip, rate per mile, and total amount, and can be easily customized to match your reimbursement policy.

This free mileage reimbursement form template helps you track mileage accurately and reimburse employees efficiently.


Employee Name

Employee ID

Department

Trip Details


Mileage rate ($ per mile)

Default rate set to current IRS standard mileage rate.

Date

Business Purpose

Start Location

End Location

Miles Driven

Total reimbursement: $