Fluent Forms Template Library

Mileage Reimbursement Form Template

Simplify mileage claims with this reimbursement form.

Mileage Reimbursement Form

Mileage Reimbursement Form
  • Employee Details
  • Vehicle
  • Trip Log
  • Totals & Certification

About this template...

This mileage reimbursement form helps HR teams, finance departments, and small businesses process claims from employees who drive their own vehicles for work. Employees submit all their trips in one form, and the reimbursement is calculated automatically.

Employees start with their name, employee ID, department, manager, and the reporting period the claim covers. They then add details about the vehicle they used, including the vehicle type, make and model, and license plate number.

In the trip log, employees add one row per trip with the date, starting point, destination, business purpose, and miles driven. The form adds up the miles, multiplies them by your per-mile rate, includes tolls and parking, and shows the estimated reimbursement. Employees can upload receipts and confirm the claim with a certification checkbox before submitting.

Mileage Reimbursement Form

Features of this Template

  • Expandable trip log so employees can add as many trips as they need
  • Total miles calculated automatically from the trip log
  • Estimated reimbursement based on your per-mile rate plus tolls and parking
  • Receipt uploads for toll and parking expenses
  • Employee, vehicle, and reporting period details for faster approval
  • Easy to customize the mileage rate, departments, vehicle types, and certification text