A blank reimbursement form in Excel, Word and printable PDF with the claim header, nine trip columns, totals, certification and signature lines.
Five files out of one set of fields. Three are the blank claim, all with the same 8 claim fields and 9 trip columns: a 60-row workbook, a 12-row editable document, and a 12-row printable sheet. The other two total the same trips by month instead, so a claim that crosses July 1 needs no rate typed over the whole year. Those two files are the claim summary.
8 claim header fields · 9 trip columns · 12 trip rows on the printable page · 60 rows in the workbook · Certification and two dated signatures
One claim, one row per trip, and the same fields whichever file you take. Each picture is the file itself, so the choice is made before the download rather than after it.
The workbook's claim sheet, with the nine columns, an Amount column that calculates each row and 60 rows ready to fill (rows 11 to 70). Five sample trips show how a row is priced. The download arrives blank. Both halves of 2026 appear as two rates because you type the rate on each row.
A claim you type and send by email. The Amount column multiplies each row's miles by the rate on that row, and the total adds the rows.
The page the Word file opens on, carrying the same claim header, nine trip columns, totals, certification and signature lines as the PDF, in a document you can reword before you send it.
A policy that has to carry its own header, wording or approval language before it can go out.
The blank sheet in US Letter landscape, with the claim header, 12 trip rows, the totals row, the certification and the two dated signatures.
A claim you fill in by hand, sign on paper, and hand to a manager with the mileage log clipped behind it.
A claim covering a month, a quarter or a year is a different document: the reviewer wants the months added up, not another row per trip. The summary prices each month at the rate in force for it, so the July 1 change needs no second file and no rate typed over the year.
The Summary sheet with a sample year entered, showing the claim header, the two rate cells (72.5 cents a mile through June 30 and 76 cents from July 1), twelve month rows, the quarter block and the signature lines. The download arrives blank.
A claim covering a month, a quarter or a year, where the reviewer wants the months added up instead of a row per trip.
The blank sheet the button downloads, with twelve month rows, a quarter block, the 2026 total, the certification and the two signature lines. The filled example beside it shows the same page with a fictional year entered.
The one page that goes to a manager when the claim covers a whole period and the trips are attached as a log.
10 labels: 8 that name the claim and the person behind it, and 2 that record the vehicle and whether the log is attached. Payroll uses the first 8 to match the claim to a person and a pay period, and the rate basis to see what the amount was priced from.
9 columns, one per trip. The first seven record the trip. The last two say who approved it and carry the notes a reviewer needs.
| Column | What goes in it |
|---|---|
| Trip date | The day the trip happened, not the day you wrote it down. In 2026 the date decides which rate the row gets. |
| Purpose | The client, site or project and the reason. "Client meeting, Cedar Park" gives a reviewer something to check. "Work" does not. |
| Start | Where the trip began. An address, an office name or a site name, whichever makes the trip easy to check. |
| Destination | Where it ended. One end on its own does not describe a trip. |
| Distance | The miles for that row, in one unit for the whole claim. Odometer differences and route distances both work, but do not mix them on one sheet. |
| Rate | The rate in force on the trip date: 72.5 cents through June 30, 2026, and 76 cents from July 1. A typed value per row, so a claim crossing the change carries both. |
| Amount | Distance times rate, rounded to cents. In the workbook this is a formula. On the paper form it is a figure you check. |
| Approval | The approver's initials or status for the row. Fill it in when the policy approves trips one by one rather than the claim as a whole. |
| Notes | Parking, tolls you claim separately, a passenger, or a policy exception. Do not put the distance here. |
The five trips in the sample, priced at the rate in force on each date. The claim starts at 72.5 cents a mile and finishes at 76 cents; the two rates are not averaged.
| Trip date | Route | Distance | Rate | Amount |
|---|---|---|---|---|
| 2026-04-03 | Austin HQ → Cedar Park | 34.0 mi | 72.5¢ | $24.65 |
| 2026-04-08 | Austin HQ → Round Rock | 18.0 mi | 72.5¢ | $13.05 |
| 2026-04-14 | Austin HQ → San Marcos | 30.0 mi | 72.5¢ | $21.75 |
| 2026-08-06 | Austin HQ → Cedar Park | 34.0 mi | 76¢ | $25.84 |
| 2026-08-12 | Austin HQ → Round Rock | 18.0 mi | 76¢ | $13.68 |
Sample total: 134.0 mi · $98.97
Four claims, four files. The three blank forms share one set of fields; the summary is the one that totals a period instead of listing its trips.
A claim covering one pay period, typed
Excel claim form
One row per trip, the amount calculated for you, and a total payroll can check line by line.
A claim covering a whole year, or a quarter
Annual claim summary (Excel)
Twelve monthly rows priced at the rate in force for each month, so a claim that crosses July 1 needs no second rate typed.
A claim signed on paper
Printable claim form
The blank sheet with the certification printed on it, for a log that lives in the glovebox.
A claim the page must sign, with a policy header
Word claim form
The same fields with editable wording, for an employer whose header, wording or approval line is not ours.
Take the Excel form to type the claim. Take the annual claim summary when the claim covers a month or more and the reviewer wants the months added up. Take the printable PDF to fill in by hand, and the Word file when the wording or the header has to change first.
Yes, with one difference: the sample has five trips entered so you can see the arithmetic. The blank files have the same claim header, the same nine columns, the same totals row and the same certification and signature lines.
Each row carries its own rate, because the IRS raised the business figure on July 1, 2026 from 72.5 cents a mile to 76 cents. A claim covering both halves of the year has both figures on it. A claim that crosses the change needs no second file.
No. Travel between home and your regular workplace is commuting, not business mileage. Keep commuting and personal trips out of the claim, or record them in their own category on a mileage log so the split is visible.
The mileage log or trip report behind the rows, and the receipts for anything outside the rate, such as parking, tolls and ferries. The rate covers the cost of operating the car, so those costs stay separate rather than being added to the distance.
No. It totals the log rather than recording it. The summary's workbook has a trip sheet you can paste your rows into, and you sign the printable summary with the log attached behind it.
No. It is a claim template an employer can adopt. The employer's policy decides what is reimbursed and which rate it follows. The IRS sets the standard rate. It does not publish a reimbursement claim form.
The layout works anywhere, but the rates printed in the samples are the US business figures and the currency is dollars. For the UK, Canada, Australia and New Zealand, use the country's own log and the rate that applies there.
Where the rate came from, what has to be attached to the claim, and the log the rows are copied from.