Hello,
HikaMarket have a system called "vendor location" ; it's composed of plugins and a module.
The goal of the feature is to let your vendors enter the list of cities and/or postcode that they can "handle".
Afterwards, the module allow a customer to enter his city (or postcode) which will be use to filter the products (via the hikashop vendor location plugin) and the vendors (via the hikamarket vendor location plugin) in the listings.
The module would also read the city/postcode information from the customer address if he is log-in and have a default address configured.
Now, if these plugins+module do not feet exactly to your needs, you still have the possibility to duplicate them and modify them as you want.
Regarding your current description, it looks to be really similar but I don't know what kind of data you have behind your screenshot interface. So it is possible that some modification (custom development) would be required.
Regards,
Jerome - Obsidev.com
HikaMarket & HikaSerial developer / HikaShop core dev team.
Also helping the HikaShop support team when having some time or couldn't sleep.
By the way, do not send me private message, use the "contact us" form instead.