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An OSM URL is made up as: http://<site>/<zoom>/<x>/<y>.png

So we can represent that in the XForms data:

     <instance>
        <data xmlns="">
           <zoom>10</zoom>
	   <x>511</x>
	   <y>340</y>
	   <url/>
	</data>
     </instance>

And we calculate the url:

     <bind nodeset="url"
	calculate="concat('http://a.tile.openstreetmap.org/',
                            ../zoom, ../x, '/', ../y, '.png')"/>

and we can input the different parts:

     <input ref="zoom"><label>zoom</label></input>

etc. Like this: