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Gas Mileage Reimbursement Form

Gas Mileage Reimbursement Form


A gas mileage reimbursement form helps recover the expenses incurred for travel from one place to another. The reimbursement claimed supported with necessary travel receipts wherever possible, along with any parking receipts. The refund of gas mileage is permitted according to the approved rate per mile assigned by the concerned authorities, which is subject to change occasionally. After receiving the gas mileage reimbursement form, the credit is usually given within five to seven business days.

Gas Mileage Reimbursement Template
Gas Mileage Reimbursement Template
Gas Mileage Reimbursement Template
Gas Mileage Reimbursement Template

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Applicant Information:

A section to record the applicant’s name, ID number, mailing address, contact information (phone number and email), age (as per driving license), date of birth, sex, and also driver’s license number.

Vehicle Information:

A section to specify the type of vehicle and also the number of miles traveled (daily details can be attached on a separate sheet).

Travel Information:

section to indicate the purpose of travel

Travel Log Attachment:

A designated space to mention that a separate travel log with detailed mileage information is attached.

Rate per Mile:

section to specify the mileage reimbursement rate.


Clarity and Organization:

The template ensures a clear and organized way to request gas mileage reimbursement by prompting the applicant to all necessary details.


Using a template promotes consistency in how mileage reimbursement requests are documented and also submitted.


The template streamlines the process for both the applicant (filling out the form) and also the approver (reviewing the request with all the required information in one place).


Having a designated space for each relevant detail reduces the risk of errors or missing information in reimbursement requests.

Important Disclaimer: These templates are for informational purposes only. They are not a substitute for legal advice. Before using any template, consult with an attorney to ensure it meets your specific needs. EditableForms.com is not a law firm and cannot accept legal requests.