CRM form that creates thematic/colored map

I'm looking to create a web form that takes data and stores it CRM and is able to be exported to excel. From there I want to be able to make thematic maps (especially USA map). Heres an example : Photographers how much do you make shooting weddings? fields = studio name, city, state, zip, average invoice, how many jobs a year after data is exported it creates a thematic map to show who charges how much in each area. Budget is $250.