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What is a Mileage Reimbursement Form?

If you have been authorized to use your personal vehicle on behalf of a company, organization or another individual, and you want to be repaid for mileage, or other related fees, you can use our Mileage Reimbursement Form as a formal record of expenses. If you have employees who you have authorized to use their own vehicle for business or other related expenses, on your behalf, you can use our Mileage Reimbursement Form to simplify the reimbursement process and make sure you are not paying back more than necessary. 
When you use a personal vehicle on behalf of another individual or company for business or other authorized purposes, it is important to record all authorized expenses related to using your personal vehicle so you can be reimbursed. The form also provides evidence to the individual or company of the exact mileage and amount for which compensation is owed. A Mileage Reimbursement Form acts as a report of expenses incurred and provides proof of the expense. Details of the Reimbursement Form include the purpose of a trip, the trip destination, and the date the trip was taken. If you have been given authorization to use your personal vehicle for business, medical events, or charitable services, this form helps to simplify the reimbursement process and provides evidence in the event of a dispute. Completing a Mileage Reimbursement Form can save employers and employees time and help make sure individuals receive reimbursement as quickly as possible.

When to use a Reimbursement Form:

  • You have to request repayment for the use of a personal vehicle.
  • You need to create mileage expense policies for your business.

Sample Mileage Reimbursement Form

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Traveler Information







Preferred Reimbursement Method:


Mileage Details



Start Location:



Fuel Cost:


Total Mileage:


Total Fuel Cost:


Total Parking Fees:


Total Toll Fees:



By: Date:


Mileage Reimbursement Form document preview

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