Vehicle Mileage Log

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Vehicle Mileage Log

Vehicle Mileage Log

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Vehicle Mileage Log

Employee Name: {{employee_name}}

Department: {{department}}

Reporting Period: {{start_date}} to {{end_date}}

Vehicle Information

Vehicle Make and Model: {{vehicle_make_model}}

Vehicle Registration Number: {{vehicle_registration}}

Starting Odometer Reading (at start of period): {{start_odometer}}

Mileage Details

Please record all business-related travel below. Each entry should include the date, origin, destination, purpose of the trip, and odometer readings.

| Date | Origin | Destination | Purpose of Trip | Start Odometer | End Odometer | Business Miles | Personal Miles |

|---|---|---|---|---|---|---|---|

| {{date_1}} | {{origin_1}} | {{destination_1}} | {{purpose_1}} | {{start_odo_1}} | {{end_odo_1}} | {{business_miles_1}} | {{personal_miles_1}} |

| {{date_2}} | {{origin_2}} | {{destination_2}} | {{purpose_2}} | {{start_odo_2}} | {{end_odo_2}} | {{business_miles_2}} | {{personal_miles_2}} |

| {{date_3}} | {{origin_3}} | {{destination_3}} | {{purpose_3}} | {{start_odo_3}} | {{end_odo_3}} | {{business_miles_3}} | {{personal_miles_3}} |

| {{date_4}} | {{origin_4}} | {{destination_4}} | {{purpose_4}} | {{start_odo_4}} | {{end_odo_4}} | {{business_miles_4}} | {{personal_miles_4}} |

| {{date_5}} | {{origin_5}} | {{destination_5}} | {{purpose_5}} | {{start_odo_5}} | {{end_odo_5}} | {{business_miles_5}} | {{personal_miles_5}} |

Summary for Reporting Period

Total Business Miles: {{total_business_miles}}

Total Personal Miles: {{total_personal_miles}}

Ending Odometer Reading (at end of period): {{end_odometer}}

Reimbursement Calculation (if applicable)

Approved Mileage Rate: {{mileage_rate}} per mile

Total Reimbursement Due: {{total_reimbursement}} (Total Business Miles x Mileage Rate)

Employee Declaration

I hereby certify that the above information is true and accurate to the best of my knowledge and that all mileage claimed was for legitimate business purposes.

Employee Signature: _____________________________

Date: {{signature_date}}

Manager Approval

Approved by: _____________________________

Manager Name: {{manager_name}}

Date: {{approval_date}}