What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you’re getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you’d like help immediately, feel free to search for a similar question, or submit your question or concern.
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You can use this widget : http://widgets.jotform.com/widget/address_map_locator
There is a demo form, however, I would like to share you the link here as well : http://form.jotformpro.com/form/50566121552954
You can clone it by following this guide : http://www.jotform.com/help/42-How-to-Clone-an-Existing-Form-from-a-URL
Also, you can find more mapping widgets on this link : https://widgets.jotform.com/category/mapping
This guide will help you to add the widget to your form : http://www.jotform.com/help/252-How-to-Add-a-Widget-to-your-Form
Hope this helps.
Feel free to contact us anytime if you need more help, we will be glad to assist you.