Building an address form and SQL-database incl. google maps

I´m looking for a simple web-form to enter addresses (company, street, zip-code, city, phone, multi selection field for scope of work). Entered data should be stored in an mySQL-Database. While entering company-name, the database should be checked for existing entries to avoid duplicate entries auto-suggestion). While entering zip-code (germany), the city-field shoud be filled automatically by using google maps API. Form should be secured with a login for different users (no complex user administration needed). Username and time of data-creation should also be stored in database. Webspace, MySQL Database and GoogleMaps API Key is available.