How can I create a form like this?

On this form, when I put in my postal code (e.g. C1B1M8), it automatically suggests stores that are close by. 

Can I accomplish this with jotform?

http://preferences.pharmasave.com/Preference.aspx

Unfortunately, we do not have a similar feature and I don't think this is easy to recreate them with conditions.

I suggest downloading your form source code instead so you can apply custom functions in your form by injecting scripts into it. 

If you have further questions, let us know.