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You would require at least three parts:
1) A server side parser such as php, asp or .NET in order to connect to a database and process the collected information
2) A database (such as mySql) to store information like regions/zones, catagories, product information, etc.
3) Basic javascript for various tasks that make life easier for your visitors (auto selecting drop-down lists, validations, etc.)
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<mgraphic /> - I don't have a solution but I admire the problem.
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