Free Mileage Reimbursement Form Template: PDF and Excel CSV

It works for employees claiming miles from an employer, and for small businesses that need a simple form. Below the form is a short sample mileage reimbursement policy you can adapt. This is not tax or legal advice.

Download the form

Printable PDF: 1 letter-size page, portrait, with 16 trip lines, totals, a statement for the employee to sign, and an approval line.
Spreadsheet (CSV): the same trip columns plus rate and amount, with one example row. It opens in Excel, Numbers, and Google Sheets.

Both are free, with no sign-up. If your employer has its own form, use that one: this one is a general template.

How to fill it in

Header: your name, department, the period the form covers, and the vehicle you drove.
Rate: the rate per mile in your employer’s policy. Many employers use the IRS rate: 72.5 cents a mile through June 30, 2026, and 76 cents from July 1, 2026.
One line per trip: date, where you started, where you went, the business purpose, and the miles. Add parking and tolls if your employer pays them, and attach the receipts.
Leave out your commute. The drive between home and your regular workplace isn’t a business trip. A drive from home straight to a client or another temporary work site is different: if you have a regular workplace, the IRS counts it as business at any distance (see commuting miles). Many employers still subtract your normal commute from trips that start or end at home. That is a company policy, not an IRS rule, so follow your employer’s policy.
Totals: miles × rate = mileage amount. If the period crosses July 1, 2026, use the two lines on the form: miles through June 30 at the earlier rate and miles from July 1 at the new one. Add parking and tolls for the total due.
Sign and date it, and hand it in on time. Under IRS accountable-plan rules, a report within 60 days of the trip is on time; many employers ask for it monthly.

A filled-in example

A field technician claims three round trips in September 2026, at the IRS rate of 76 cents:

Example mileage reimbursement claim
Date	From	To	Business purpose	Miles	Parking and tolls
Sept. 8	Office	Client site, 450 Elm St.	Quarterly equipment check	23	$6.00
Sept. 8	Client site, 450 Elm St.	Office	Return	23	—
Sept. 15	Office	Supplier, Route 9	Parts pickup	31	—
Sept. 15	Supplier, Route 9	Office	Return	31	—
Sept. 22	Office	Branch office, Dayton	Training session	64	$3.50
Sept. 22	Branch office, Dayton	Office	Return	64	—

Total: 236 miles × $0.76 = $179.36, plus $9.50 in parking and tolls = $188.86 due.

If a claim covers dates on both sides of a rate change, like June and July 2026, total the miles before and after the change separately; the PDF has a line for each. The mileage reimbursement calculator does that for you, and the IRS mileage rate page lists every rate by date.

Using the spreadsheet version

Excel: open the CSV file, then save it as an .xlsx workbook so your formulas are saved.
Google Sheets: File → Import → Upload, and pick the CSV file.
Amount formula: in row 2, type =E2*F2 in the Mileage amount column (miles × rate), then copy it down.
Totals: under the last row, use =SUM(E2:E200) for miles, =SUM(G2:G200) for the mileage amount, and =SUM(H2:H200) for parking and tolls.

Delete the example row before you start. Print the sheet or export it as a PDF, then sign it.

Mileage reimbursement policy: what to include

A written mileage reimbursement policy tells employees what is paid, how to claim it, and by when. To keep payments tax-free for employees, the plan has to meet the IRS accountable-plan rules: business miles only, a timely report of each trip, and any excess paid back. A policy usually covers:

Who it covers and which trips count, with commuting left out.
Trips that start or end at home: whether you pay the whole trip or subtract the employee’s normal commute. Subtracting it is a common company choice, not an IRS requirement.
The rate: the IRS rate for the date of the trip, or a fixed company rate. The IRS rate is the most you can pay per mile without the excess being taxable.
What to submit: date, start and end points, purpose, and miles of each trip, plus receipts for parking and tolls.
Deadlines: for example, monthly, and no later than 60 days after the trip.
Approval and when payment is made.
State law: some states require employers to cover necessary work expenses. Check mileage reimbursement laws by state.

The tax rules behind this are in employee mileage reimbursement rules.

Sample policy text

A starting point to adapt with your own numbers. Have it reviewed for your state before you use it.

Mileage reimbursement policy. Employees who drive a personal vehicle for company business are reimbursed at the IRS standard mileage rate in effect on the date of each trip. Business trips include travel between work sites, to clients and suppliers, and to training. Travel between an employee’s home and regular workplace is commuting and is not reimbursed.

To be reimbursed, submit the mileage reimbursement form each month, and no later than 60 days after the trip. List the date, starting point, destination, business purpose, and miles of each trip, and attach receipts for business parking and tolls. Your manager approves the form, and payment is made with the next regular payroll or expense run.

Any advance or overpayment above the amount you account for must be returned within 120 days.

FAQ

Is this mileage reimbursement form free?

Yes. The PDF and the CSV file are free to download, print, copy, and change, with no sign-up.

What rate should I write on the form?

The rate in your employer’s policy. If the policy says “the IRS rate,” use the rate for the date of each trip: 72.5 cents a mile through June 30, 2026, and 76 cents from July 1, 2026.

How often should I submit a mileage reimbursement form?

Follow your employer’s schedule. Monthly is common. Under the IRS safe-harbor rule, reporting within 60 days of the trip keeps the payment tax-free under an accountable plan.

Do I need to attach a mileage log?

The form itself lists each trip, so it can serve as the log. If you track trips day to day in a separate mileage log, attach a copy or keep it ready in case your employer asks.

Sources

IRS, Publication 463, chapter 6 (accountable plans, reasonable period of time) and chapter 5 (records) (checked November 12, 2026): irs.gov
IRS, Publication 15 (2026), section 5 (accountable plans) (checked November 12, 2026): irs.gov
IRS, Standard mileage rates (Notice 2026-10, Announcement 2026-11) (checked November 12, 2026): irs.gov