Request Client details with google map

Hi there,

I am busy creating a form that gathers the client details for s site survey for our wireless access, i have a little problem where i need to gather the client`s address details, from there, the form must chow the client`s position in google maps (i have created a coverage area). Can someone please show me the best solution or where i can get more info on this, it is really urgent.

Form code:

div class="TTWForm-container">
      
      
     <div id="form-title" class="form-title field">
          <h2>
               Request Site Survey
          </h2>
     </div>
      
      
     <form action="process_form.php" class="TTWForm" method="post" novalidate="">
           
           
          <div id="field1-container" class="field f_100">
               <label for="field1">
                    * Your Name
               </label>
               <input type="text" name="client_name" id="field1" required="required">
          </div>
           
           
          <div id="field2-container" class="field f_100">
               <label for="field2">
                    * Mobile Number
               </label>
               <input type="text" name="client_mobile" id="field2" required="required">
          </div>
           
           
          <div id="field9-container" class="field f_100">
               <label for="field9">
                    * Email Address
               </label>
               <input type="email" name="client_email" id="field9" required="required">
          </div>
           
           
          <div id="field3-container" class="field f_100">
               <label for="field3">
                    * Steet Address and Building Number
               </label>
               <input type="text" name="client_street" id="field3" required="required">
          </div>
           
           
          <div id="field4-container" class="field f_100">
               <label for="field4">
                    * Suburb
               </label>
               <input type="text" name="client_suburb" id="field4" required="required">
          </div>
           
           
          <div id="field11-container" class="field f_100">
               <label for="field11">
                    * City
               </label>
               <input type="text" name="client_city" id="field11" required="required">
          </div>
           
           
          <div id="field8-container" class="field f_100">
               <label for="field8">
                    * Product Required
               </label>
               <select name="client_product" id="field8" required="required">
                    <option id="field8-1" value="Internet Only">
                         Internet Only
                    </option>
                    <option id="field8-2" value="Telephone Only">
                         Telephone Only
                    </option>
                    <option id="field8-3" value="Internet and Telephone">
                         Internet and Telephone
                    </option>
               </select>
          </div>
           
           
          <div id="form-submit" class="field f_100 clearfix submit">
               <input type="submit" value="Submit">
          </div>
     </form>
</div>

Select allOpen in new window

Google map link:
http://maps.google.com/maps/ms?hl=en-AU&ie=UTF8&msa=0&msid=205116966782415439308.00049f737ade271d2b6b1&ll=-29.117375,26.213379&spn=0.173363,0.338173&t=h&z=12