Walkthrough
How to Fill Out a Mileage Reimbursement Form
A filled five-trip claim you can read line by line: the claim header, both 2026 rates, the running total, the certification and the approval that closes it.
Read a finished claim line by line before you write your own. The header names the claim and the person. Each trip row carries its own date, route, purpose, miles and rate. The total adds the rows, and the certification and approval close it.
Open it in Sheets or Excel to check the column order.
Use the printable example to review the layout and the approval.
Preview
| Employee | Trip date | Purpose | Distance | Rate | Amount | Approval |
|---|---|---|---|---|---|---|
| Taylor Rivera | 2026-04-03 | Client meeting | 34.0 mi | $0.725 | $24.65 | Approved |
| Taylor Rivera | 2026-04-08 | Site visit | 18.0 mi | $0.725 | $13.05 | Approved |
| Taylor Rivera | 2026-04-14 | Supply pickup | 30.0 mi | $0.725 | $21.75 | Approved |
| Taylor Rivera | 2026-08-06 | Client meeting | 34.0 mi | $0.760 | $25.84 | Approved |
| Taylor Rivera | 2026-08-12 | Site visit | 18.0 mi | $0.760 | $13.68 | Approved |
What to track
- Employee name and employee ID
- Department or cost center
- Company or employer
- Claim period and date submitted
- Distance unit and rate basis
- Vehicle or plate and mileage log
- Trip date and business purpose
- Start and destination
- Miles or kilometres
- Rate used and amount
- Approval
- Notes
- Certification and signatures
How each line is filled
- The header first: employee, employer, claim period and the date submitted, so a reviewer knows whose claim this is before reading a row.
- Then one row per trip: the date decides the rate, so the April rows carry 72.5 cents and the August rows 76.
- The amount on a row is miles times that row's rate. The total under the table adds the amounts rather than re-pricing the distance.
- Notes hold what the row cannot, such as an approval date. The certification and both signatures close the claim.
How to use
1. Download the template and duplicate it for each month.
2. Fill each row immediately after a trip to avoid missing details.
3. Run the calculator and reconcile totals before submitting.
4. Continue to US Mileage Reimbursement Calculator.
Sample claim rows
2026-04-03 · Taylor Rivera
Austin HQ -> Cedar Park -> Austin HQ
Client meeting · 34.0 mi · $24.65
Approved by manager on 2026-04-05
2026-04-08 · Taylor Rivera
Austin HQ -> Round Rock -> Austin HQ
Site visit · 18.0 mi · $13.05
Parking claimed separately.
2026-04-14 · Taylor Rivera
Austin HQ -> San Marcos -> Austin HQ
Supply pickup · 30.0 mi · $21.75
Round trip.
2026-08-06 · Taylor Rivera
Austin HQ -> Cedar Park -> Austin HQ
Client meeting · 34.0 mi · $25.84
Rate changed on July 1.
2026-08-12 · Taylor Rivera
Austin HQ -> Round Rock -> Austin HQ
Site visit · 18.0 mi · $13.68
Mileage log attached.
Continue with tools
Move from the form into the calculator, policy template, or sample page.