Mileage Reimbursement Form

Employees that receive an auto allowance will not be reimbursed for mileage. Also, the IRS considers the daily commute between your home and your main or regular place of work to be a personal expense, and therefore, not eligible for tax deductions or mileage reimbursement. Likewise, USA Industries does not reimburse employees for their regular commute. When calculating mileage for reimbursement, you must exclude the mileage you would have otherwise incurred as your normal commute if you did not go to the office first.

EMPLOYEE INFORMATION

Name

First

Last

Department:

Supervisor/Manager:

Date

Purpose of Trip:

Was This a Round Trip?

Yes

Origin Address

Destination Address

Directions Panel

One Way Trip Total Miles Equals

Round Trip Total Miles Equals

Mileage Reimbursement Amount: ($.725 per mile)

Enter Company Credit Card Charge(s)

Mileage Backup (receipts, etc.)

Maximum file size: 516MB

Expected Reimbursement

CERTIFICATION

I certify that the above information is accurate and that the miles claimed were incurred while conducting company business in accordance with company policies.

Signature

Clear

Today's Date

If you are human, leave this field blank.

mileage

MILEAGE REIMBURSEMENT FORM

USAI Mileage
Reimbursement Form

EMPLOYEE INFORMATION

CERTIFICATION

S. Houston, Texas:

Prairieville, Louisiana:

Corpus Christi, Texas:

Company Info.

Contact Information

USAI MileageReimbursement Form

EMPLOYEE INFORMATION

CERTIFICATION

USAI Mileage
Reimbursement Form