Distance calc and form submit using Google maps

I need script that take the form as shown attached From TO and go to google maps. and find total miles from From address to To: Address and based on miles total calculate the total quote price for transport/Ride I want an area in script where i can change param called #PricePerMile# = So I can control Price per mile Also another Param is Airport Fee #AirportFee# = which intially is = 0 but I can change that and your total price base don google maps distance and miles can also add this value to total price So that is all need to be in PHOp/MYSQL See attached the form in home page and how will look after submission will show price U only program no design and we will give you the live form and you must make it with error validation and to do and show the next form frame after submission with price based on total miles and what I mentioned above