FIN - SVA Intranet - Mileage Reimbursement | Southern Vision Alliance PowerBase

Please complete this form to submit a mileage reimbursement for payment.

Effective July 1, 2026, the IRS mileage rate is $0.76. Please be sure to use the updated Mileage Reimbursement Spreadsheet at the bottom of this form for correct mileage reimbursement amount calculations.

***NOTE: Standard payment turnaround time is 2-4 weeks. If you request a payment be made within 2 weeks, SVA may charge a $50 expedited payment fee. We cannot guarantee expedited payments.**

Organization/Program Information

Organization Name

Organization Name
Organization Name

Your Info

First Name

First Name
First Name

Last Name

Last Name
Last Name

Phone Number

Phone Number
Phone Number

Person or Entity receiving payment (Full legal name of payment recipient required):

First Name

First Name
First Name

Middle Name

Middle Name
Middle Name

Last Name

Last Name
Last Name

Email
Email

Physical mailing address of check recipient

State/Province

Street Address

Street Address
Street Address

Supplemental Address (Apt #, Suite, etc.)

Supplemental Address (Apt #, Suite, etc.)
Supplemental Address (Apt #, Suite, etc.)

City

City
City

Zip Code

Zip Code
Zip Code

Payment Information

Describe your mileage reimbursement.

Describe your mileage reimbursement.
Describe your mileage reimbursement.

Amount of Payment

Amount of Payment
Amount of Payment $

The payee already has a contract on file with SVA

Yes

N/A

The payee already has a current W9 on file with SVA

Yes

Payment Type

Standard Payment (2-4 weeks)

Expedited Payment (less than 2 weeks, may incur $50 fee)

Payment Method

Check

BILL.com electronic payment (Payment recipient BILL.com Network ID Number required)

Payment recipient BILL.com Network ID Number

Payment recipient BILL.com Network ID Number
Payment recipient BILL.com Network ID Number

Should this payment be expensed to a grant?

Yes

Grant Name

Grant Name
Grant Name

Documentation

Please use the fields below to upload copies of invoices, receipts, and/or the payee's W9. If we already have a current contract and W-9 on file, you do not need to attach them here. The payee must complete a W9 via Xodo available here. *Please note that we cannot make payments if we do not have a W-9 on file.*

Mileage Reimbursement Form (Download the form to complete and upload by clicking here)

One file only.
30 MB limit.
Allowed types: gif, jpg, jpeg, png, txt, rtf, html, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml.