Inserting Contents of a form into MySQL

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PHP

When i fill out my form and submit it it says submitted successfully however when i look in my MySQL database there is not record added. What have i done wrong.

This is my inserting php code:

<?
 $name=$_POST['name'];
 $time = date('l jS \of F Y h:i:s A');
 $email=$_POST['email'];
 $location=$_POST['location'];
 $sex=$_POST['sex'];
 mysql_connect("quollcraft.net", "quollcr1_forum", "PASSWORD") or die(mysql_error());
 mysql_select_db("quollcr1_hub") or die(mysql_error());
 mysql_query("INSERT INTO `data` VALUES ('$Username', '$name', '$email', '$location', '$sex'. '$time')");
 Print "Your information has been successfully added to the database.";
 ?>

This is my form:

<form action="process.php" method="post">
About: <input type="text" name="name"><br>
Location: <input type="text" name = "email"><br>
Interests: <input type="text" name = "location"><br>
Gender: <input type="text" name = "sex"><br>
 <input type="submit" value="Submit">
 </form>